Clinician: Trevisan Gianfranco
A 54-year-old male, employed as a refrigerated truck driver and not engaged in regular physical activity, presented for evaluation reporting a progressive reduction in foot sensitivity associated with bilateral lower limb paresthesia, present for approximately one year. The patient described a marked difficulty in perceiving plantar support, accompanied by a sensation of weakness in the lower limbs, resulting in gait instability and difficulty modulating pressure on the pedals while driving. He also reported the need to use a handrail when ascending and descending stairs. Medical history revealed that the onset of symptoms occurred concomitantly with a surgical procedure involving the placement of an aortic stent; the patient reported having already undergone instrumental examinations and specialist evaluations for the current condition. Past medical history included a left ankle trauma approximately ten years earlier, which had led to gait with mild external rotation of the left lower limb. No other relevant traumatic events or pathological conditions were reported. Given the history of surgery involving the circulatory system and the temporal correlation with symptom onset, the initial clinical hypothesis was oriented toward a dysfunction of the Circulatory Apparatus, with consequent alteration of the fascial biomechanical model and the related chain.
During observation on the treatment table, the lower limbs appeared edematous, with evident cyanotic discoloration of the feet; toe mobility was markedly reduced, making both active and passive mobilization difficult. For this reason, palpatory verification was initially performed at the trunk level, avoiding direct palpation of the lower limbs. Assessment revealed a dysfunction of the antero-posterior (AP) tensor, with significant densifications at AN-ME-TH2 left, AN-ME-CL right, and AN-ME-CA1 bilaterally, with AN-ME-CL right being particularly painful. Treatment was therefore initiated at this point, alternating with work on AN-ME-TH2 left, which represented the second most painful point. During the early phases of treatment, the patient immediately reported a subjective sensation of “flow” along the lower limbs reaching the feet; after approximately one minute, a progressive reduction in cyanotic discoloration was observed. After a few minutes from the start of the session, the patient reported increased perception of the feet and reduced stiffness, with improved ability to move the toes. Subsequently, the bilateral AN-ME-CA1 points were also treated. At the end of the session, the patient was invited to stand upright and reported, with surprise, a clear perception of plantar support, improved stability both in static stance and during gait, and a sensation of increased strength in the lower limbs. Clinical observation confirmed a marked reduction in edema and cyanotic discoloration of the feet.
At the follow-up session ten days later, the patient reported stable improvement of symptoms: plantar support was clearly perceived, toe mobility had normalized, stair negotiation was possible without handrail support, and pedal force modulation during driving had significantly improved. Edema was reduced by more than half, and skin coloration appeared almost completely normalized. Palpatory verification revealed residual densifications at AN-ME-CL right, AN-TH left, and AN-ME-LU1 right. After treating these points, the patient was positioned prone and the bilateral RE-ME-TH2 points, which were also densified, were treated. At the end of the session, the patient reported further normalization of plantar sensitivity, improved motor control, and increased perceived strength in the lower limbs; clinically, edema was further reduced and cyanotic discoloration had completely resolved. A biweekly telephone follow-up for three months was therefore agreed upon to monitor the stability of the achieved results, postponing to a later stage the specific treatment of the residual left ankle condition.