Follow up: Patient reported some relief of abnormal tone for up to 3 days. Had aching posterior thigh the day of treatment which resolved. Patient is also a diabetic.

In response to the DVT. While not a contraindication it is always advisable to check with the patients physician to ensure it is appropriate to needle.

It sounds like a typical nerve referral in the saphenous nerve distribution into the medial foot. Intense obviously, was this her first time needling? It good to hear there was a positive lasting effect.

As far as vericosities if the veins have an abnormal appearance I would choose to go proximal or distal to that area to avoid needling the structure itself.

Let me know if that helps and any follow ups.

Thank you for your response Nicholas. The Saphenous could definitely tie in with some of her plantar symptoms though I have not needled it directly due to concern over her lower leg swelling. Interestingly enough, I needled a second time in 2 weeks and followed my original points (Iliotibial homeostatic point and Adductors with three 2" needles along each), and she noted mild increases in lateral knee and proximal thigh sensation as well as a minimal decrease in the abnormal walking on a high heel sensation in her foot. She also feels out of control with the leg, but I attribute that to the tone changes. I should add that her DVT history is remote ('80s) and they were in the calf. Also, she has no clear varicosities just congestion lower legs and worse on the right which likely relates to decreased muscle activity and arch collapse. I am contemplating putting her in compression garments to try to control the swelling and then considering needling lower.

Interesting case for sure. Why do they think she has he swelling?

Is it cardiac, lymphatic, or local vascular/tone issues?

Also, out of curiosity have you needled her paravertebrals at all?