American   Academy   f   Manual   Medicine

Home  Search  Pain referral  Trigger points  Cranial nerve  Spinal nerve  Historical  About us  Contact us  Site map 


Pointer Plus

Pointer Plus

The Pointer Plus is an easy to use trigger point (TP) locator which incorporates a push button stimulation feature to immediately treat Trigger point pain.


The Lumbricals are deep intrinsic muscles of the foot.

Anatomical Attachments:

  • Origin: There are 4 lumbricals, all ascending from the tendons of the flexor digitorum longus. Each tendon attaches to the medial side of the four lateral toes.
  • Insertion: Attach with the tendons of the extensor digitorum longus and the interossei on the dorsal surface of all toes except for the great toe.

Action: Flex the toes at the MP joints and extends the toes at the DIP and PIP joints.

Synergist: Quadratus plantae, Flexors Digitorum longus and brevis, Interossei.

Antagonist: Extensors Digitorum longus and brevis.

Nerve Supply: Medial plantar nerve (L4, L5), deep lateral plantar nerve (S1, S2).

Vascular supply: Plantar metatarsal artery.

Travell and Simons Trigger Point Pain Referral:  

Trigger Point Signs and Symptoms: There is a difficulty in walking, paresthesia or edema of the foot, and deformity of the toes.

Trigger Point Activating and Perpetuating Factors: Wearing shoes that are too small, wearing a cast shoe for a long period of time, injury to the foot or toes.

Differential Diagnosis: Plantar fasciitis, Plantar warts, Hallux valgus, Stress fractures, Charcotís arthropathy, Frostbite, Diabetic neuropathy, Polyneuropathy, Foot trauma, Prolonged immobilization or dependency of the legs, Hammer toe, (Segmental, Subluxation, Somatic dysfunction) L4 L5 S1 or S2 radiculopathy, Nerve entrapment, If bilateral swelling consider Congestive heart disease (edema), Osteoarthritis, Rheumatoid Arthritis, Gout, injured sesamoid bone, Hip or knee discomfort secondary to antalgic gait, Osteoporosis, Complex regional pain syndrome (Reflex sympathetic dystrophy), Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication, With a positive Babinskiís toe sign suspect a Central nervous system (CNS) lesion.


Back to Top


Return to Search 


Home  Search  Pain referral  Trigger points  Cranial nerve  Spinal nerve  Historical  About us  Contact us  Site map 

Continuing Education © Copyright 2001, 2004, 2006. All rights reserved.