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If a patient has Morton’s neuroma , formulate and evaluate an assessment and management plan for the patients presentation worth eight marks, provide the clinical working diagnosis with one mark, what gait alterations may be observed in patients worth three marks, designs and evaluate a foot orthosis for the management of the patients presentation worth five marks, include this LO1 - Formulate and evaluate evidence-based podiatric assessment and management plans for a range of musculoskeletal disorders commonly encountered within podiatry clinics LO2 - Analyse methods of gait analysis and identify how these can be used in the assessment of common musculoskeletal conditions. LO3 - Evaluate the use of orthoses in the management of foot health

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"Morton neuroma" AND treatment

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PMID: 38334217

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I now have sufficient evidence from the textbooks and the Cochrane 2024 review to construct a comprehensive, mark-scheme-mapped academic answer. Here it is:

Morton's Neuroma — Comprehensive Podiatric Academic Answer

Clinical Working Diagnosis (1 Mark)

Interdigital neuritis (Morton's neuroma) — a compressive neuropathy of the common plantar digital nerve, most frequently occurring in the third intermetatarsal web space (occasionally the second), characterised by perineural fibrosis and nerve enlargement secondary to chronic compression beneath the deep transverse metatarsal ligament (DTML).
"A Morton's neuroma is an enlarged common plantar nerve, usually in the third interspace between the third and fourth toes... the lateral plantar nerve often unites with the medial plantar nerve. As the two nerves join, the resulting nerve is typically larger in diameter." — Gray's Anatomy for Students

LO1 — Assessment and Management Plan (8 Marks)

A. Podiatric Assessment

Subjective History

A thorough subjective history forms the foundation of any evidence-based assessment. Key areas to explore include:
  • Chief complaint: Burning, sharp or shooting pain in the forefoot web space, often radiating into the toes; a sensation of "walking on a pebble" or a bunched-up sock
  • Symptom behaviour: Worsened by weight-bearing, particularly during propulsion; relieved by shoe removal and rest
  • Footwear history: Use of narrow toe-box shoes or high heels — a critical aetiological factor. Symptoms typically absent in sandals
  • Duration and onset: Acute exacerbation vs. gradual progressive onset
  • Aggravating/relieving factors: Walking barefoot vs. enclosed footwear; impact activity
  • Medical and social history: Previous foot pathology, diabetes, inflammatory arthropathies, occupation (prolonged standing)
  • Patient-reported outcome measures (PROMs): MFPDI (Manchester Foot Pain and Disability Index) or VAS (Visual Analogue Scale) to quantify pain severity at baseline
"Patients frequently report pain and burning on the plantar aspect of the web space, with more than 60% of patients noting pain radiating into the toe distally; numbness is reported by only 40% of patients." — Miller's Review of Orthopaedics, 9th Edition

Objective Examination

Inspection:
  • Assess footwear for narrow toe box, heel height, wear patterns (indicates loading distribution)
  • Inspect for hallux valgus, hammer toes, clawing — associated deformities that increase forefoot compression
  • Assess foot posture: pronated foot type narrows the intermetatarsal space; pes cavus increases forefoot pressure
Palpation:
  • Mulder's click test (Mulder's sign): Applying a lateral squeeze to the metatarsal heads while simultaneously pressing the web space from the plantar aspect produces a palpable/audible "click" and reproduction of pain — positive in up to 60–70% of cases
  • Direct plantar palpation between and just distal to the metatarsal heads to reproduce the burning pain
  • Assess for dorsal tenderness (to exclude stress fracture of metatarsal neck)
Neurological assessment:
  • Sensory testing (Semmes-Weinstein monofilaments or two-point discrimination) in the web space and adjacent toes to identify hypoaesthesia or paraesthesia
  • Sharp/blunt discrimination to differentiate from peripheral neuropathy
Vascular assessment:
  • Capillary refill time, skin temperature, and palpation of dorsalis pedis and posterior tibial pulses to exclude ischaemic causes of forefoot pain
Differential diagnosis exclusion:
  • Metatarsalgia: Diffuse forefoot pain without the neurogenic quality
  • MTP joint synovitis: Dorsal swelling, positive drawer test
  • Stress fracture: Bony tenderness along metatarsal shaft
  • Plantar plate tear: MTP instability on dorsal drawer test
"Metatarsalgia and MTP synovitis often manifest similarly and should be ruled out." — Miller's Review of Orthopaedics, 9th Edition

Investigations

  • Plain radiographs (weight-bearing AP, lateral): To exclude bony pathology (osteophytes, stress fracture, metatarsal deformity)
  • Ultrasound (US): First-line imaging; demonstrates a well-defined hypoechoic mass in the plantar web space, which can be displaced with lateral compression. Cost-effective and dynamic
  • MRI: Gold standard for soft tissue characterisation; the neuroma appears as low signal intensity on T1 and T2 sequences in the web space, best visualised in the axial plane. Useful when diagnosis is uncertain or when multiple neuromas are suspected
"US rarely identifies a nerve entering the mass, but does show a well-defined area of low reflectivity in the plantar aspect of the web space... MRI shows the neuroma best on images orientated in the short axis of the web space and its low SI reflects its fibrotic nature." — Grainger & Allison's Diagnostic Radiology

B. Management Plan (Evidence-Based, Stepped Approach)

Step 1: Conservative — First-Line (Weeks 0–12)

1. Footwear modification The most important and effective non-surgical intervention. Patients must be counselled to:
  • Avoid shoes with narrow toe boxes and high heels (>2 cm heel elevation increases forefoot loading by ~25%)
  • Transition to wide, low-heeled footwear with adequate depth in the toe box to reduce compression of the DTML on the nerve
  • Consider lacing modifications (skipping the third lace eyelet) to widen the forefoot
"Shoewear modification (avoiding high heels and narrow toe boxes) is the most important and effective intervention." — Miller's Review of Orthopaedics, 9th Edition
2. Foot orthosis A custom or prefabricated orthosis with a metatarsal dome/pad placed proximal to the metatarsal heads (see LO3 below for full design evaluation).
3. Activity modification Temporary reduction in high-impact activities, particularly those involving toe-off on hard surfaces. Patient education on load management.

Step 2: Pharmacological and Injection Therapy

Corticosteroid and local anaesthetic injection (CS+LA):
  • Most commonly used second-line intervention
  • Typically 1 mL methylprednisolone acetate 40 mg/mL with local anaesthetic under ultrasound guidance
  • Moderate effectiveness: approximately 50% of patients report short-term relief
However, the 2024 Cochrane Systematic Review (Matthews et al., PMID 38334217) found that CS+LA may result in little to no difference in pain (MD -6.31 mm VAS, 95% CI -14.23 to 1.61; low-certainty evidence) or function compared to local anaesthetic alone. It noted that:
  • CS+LA probably results in little to no difference in HRQoL vs. LA alone (moderate-certainty evidence)
  • Repetitive corticosteroid injections risk hammer-toe deformity and fat pad atrophy
Alcohol sclerosing injections: Not recommended — insufficient evidence of effectiveness (Miller's Review of Orthopaedics, 9th Edition).

Step 3: Extracorporeal Shockwave Therapy (ESWT)

A non-invasive option for patients who have failed conservative measures. A systematic review and meta-analysis (Tengku Yusof et al., 2022, PMID 34878537) examined ESWT for foot and ankle disorders; limited but emerging evidence exists for its use in neuroma. Can be considered in specialist settings prior to surgical referral.

Step 4: Surgical Intervention

Reserved for patients who have failed 3–6 months of conservative management:
  • Neurectomy (neuroma excision): Dorsal approach is most common. The DTML is incised and the common digital nerve resected 2–3 cm proximal to the ligament, allowing the proximal stump to retract and minimise recurrent (stump) neuroma formation — the most common complication
  • The plantar approach provides better visualisation but carries risk of painful plantar scar
"Excision of neuroma — Dorsal approach most common... The common digital nerve and its branches are identified, and the nerve is resected 2 to 3 cm proximal to the intermetatarsal ligament, allowing the proximal stump to retract." — Miller's Review of Orthopaedics, 9th Edition
Recurrence rates are higher (4% incomplete resection via dorsal approach) but patient satisfaction is generally good. Patients must be counselled regarding permanent numbness in the web space post-operatively.

LO2 — Gait Alterations in Morton's Neuroma (3 Marks)

Gait analysis is a fundamental podiatric assessment tool for musculoskeletal conditions. In Morton's neuroma, the pathomechanical mechanism that drives symptoms — nerve compression beneath the DTML during propulsion — produces characteristic gait alterations:

1. Antalgic Gait / Reduced Propulsive Phase

The most prominent finding is a shortened stride length and reduced time in propulsion/push-off. As weight shifts onto the forefoot and the metatarsophalangeal joints dorsiflex during terminal stance and push-off, the interdigital nerve is compressed between the DTML (above) and the ground (below). Patients instinctively reduce the duration and extent of this phase to minimise pain, resulting in a shortened, guarded gait pattern.
"Typically, as the patient enters the 'push-off' phase of walking the interdigital nerve is sandwiched between the ground and the deep transverse metatarsal ligament. The forces tend to compress the common plantar nerve." — Gray's Anatomy for Students

2. Lateral Weight Transfer and Supinatory Compensation

Patients frequently shift their weight laterally — adopting a supinatory gait pattern to offload the third/fourth web space (the most common site). This produces:
  • Increased lateral forefoot loading (beneath the 4th/5th metatarsal heads)
  • Visible lateral foot deviation during midstance and propulsion on pedobarographic or pressure plate analysis
  • Compensatory toe-out (abductory twist) as patients roll off the lateral border of the foot rather than through the central forefoot
In pedobarographic gait analysis, this presents as a shift in the centre of pressure (COP) trajectory laterally during propulsion, with reduced peak pressure under the 2nd/3rd metatarsal heads.

3. Reduced Cadence, Altered Shoe-Off Behaviour, and Toe Purchase Reduction

  • Reduced cadence and slower walking speed as the patient moderates forefoot loading
  • Reduced hallux and lesser toe plantarflexion during push-off to minimise dorsiflexion at the MTPJs (which compresses the nerve)
  • Patients are often observed to remove their shoe and massage the forefoot during gait analysis rest periods — a hallmark clinical sign
Gait analysis methods applicable:
  • Observational gait analysis (OGA): Low cost; identifies gross antalgic pattern and lateral weight transfer
  • Pedobarography / pressure plate analysis: Quantifies regional forefoot plantar pressures and COP trajectory; most clinically useful for identifying lateral offloading compensation and reduced 3rd metatarsal head loading
  • 3D motion capture / instrumented gait analysis: Provides kinematic data on MTP dorsiflexion angles, ankle kinematics, and cadence — useful in complex or research settings

LO3 — Foot Orthosis Design and Evaluation (5 Marks)

Design of Foot Orthosis for Morton's Neuroma

The primary mechanical goal of foot orthosis therapy is to decompress the common plantar digital nerve by redistributing plantar pressure, separating the metatarsal heads, and reducing the compressive forces generated by the DTML during propulsion.

Orthosis Specification

ComponentSpecificationRationale
TypeCustom semi-rigid functional orthosis with forefoot modificationAllows full control of the subtalar joint and forefoot simultaneously
Shell material3–4 mm polypropylene (semi-rigid)Sufficient rigidity to control pronation while allowing some shock absorption
Shell lengthSulcus length (to the metatarsal sulcus)Allows metatarsal modifications to exert effect; avoids pressure on the neuroma directly
Metatarsal dome/padEVA dome (30–45 Shore A hardness), 6–8 mm height, placed proximal to the 2nd–4th metatarsal headsThis is the critical element — the dome mechanically splays and elevates the metatarsal shafts, increasing the intermetatarsal space and reducing nerve compression under the DTML during propulsion
Metatarsal dome positioningApex of dome at the proximal margin of the MT heads (approximately 1–2 cm proximal to MTPs)If placed distal to the heads, the dome exacerbates pressure on the neuroma
Rearfoot postingMedial heel wedge / intrinsic rearfoot post (0–4° valgus correction for pronated foot)Pronated foot posture reduces intermetatarsal space; correcting subtalar/midtarsal pronation widens the space and reduces DTML tension
Heel cup depth12–15 mm deepOptimises hindfoot stability and shock distribution
Top cover3 mm PPT (Poron) full-lengthProvides cushioning and accommodates any residual plantar pressure
Void/cut-outOptional localised cut-out beneath the 3rd web space in the top coverDirect pressure relief over the neuroma if palpable mass is present
"Metatarsal pads placed proximal to the focus of pain can prevent direct pressure and widen the intermetatarsal space during weight bearing, thereby indirectly decompressing the nerve." — Miller's Review of Orthopaedics, 9th Edition

Evaluation of the Orthosis

Biomechanical justification: The metatarsal dome is the most evidence-supported component. By placing a raised dome proximal to the metatarsal heads, the vertical load is shifted proximally along the metatarsal shafts. This:
  1. Reduces the compressive force at the MT head level (where the nerve is located)
  2. Mechanically forces the metatarsals to splay, incrementally widening the intermetatarsal space and reducing DTML tension
  3. Decreases the degree to which the nerve is "sandwiched" during the propulsive phase
The rearfoot post addresses the underlying biomechanical risk factor of excessive subtalar pronation, which exacerbates forefoot splaying and forefoot instability.
Limitations and evaluation criteria:
  • Footwear compatibility: The orthosis must be used in footwear with a wide, deep toe box. If the patient continues to wear narrow footwear, the orthosis will have limited efficacy (the external compression nullifies the metatarsal splay effect)
  • Evidence base: While metatarsal pads are widely used in clinical practice, the 2024 Cochrane Review (Matthews et al., PMID 38334217) found insufficient RCT evidence for foot orthoses specifically; it noted this is a research gap, not evidence of inefficacy
  • Review protocol: Orthosis efficacy should be re-evaluated at 6–8 weeks using VAS scores, MFPDI, and pedobarographic reassessment. If insufficient pressure redistribution is achieved, dome height or position should be adjusted
  • Combined approach: Orthosis alone is unlikely to resolve Morton's neuroma; it functions most effectively as part of a stepped management plan that includes footwear modification, patient education, and injection therapy if required

Summary Table

DomainKey Point
Working DiagnosisInterdigital neuritis (Morton's neuroma), 3rd web space
AssessmentHistory, Mulder's test, neurological/vascular screen, imaging (US/MRI), PROMs
ManagementFootwear modification → orthosis → CS injection → ESWT → neurectomy
GaitAntalgic propulsion, lateral weight transfer, reduced cadence
OrthosisSulcus-length semi-rigid shell + proximal metatarsal dome + pronation correction

Key References

  • Matthews BG et al. (2024). Treatments for Morton's neuroma. Cochrane Database Syst Rev. PMID: 38334217 — Cochrane review of 6 RCTs (373 participants); low-certainty evidence that CS+LA offers no significant pain benefit over LA alone
  • Samaila E et al. (2021). Effectiveness of corticosteroid injections in Civinini-Morton's Syndrome. Foot Ankle Surg. PMID: 32600970
  • Miller's Review of Orthopaedics, 9th Edition — Interdigital Neuritis (Morton Neuroma), p. 513–514
  • Gray's Anatomy for Students — Morton's Neuroma, p. 768
  • Goldman-Cecil Medicine — Morton Neuroma, p. 2781
  • Grainger & Allison's Diagnostic Radiology — Morton's Neuroma, p. 1075---
Here is a breakdown of how this answer maps to each mark allocation:
Clinical Working Diagnosis (1 mark): Interdigital neuritis (Morton's neuroma), 3rd intermetatarsal web space — named, anatomically located, mechanism stated.
Assessment & Management Plan (8 marks):
  • Marks 1–2: Thorough subjective history with symptom characterisation and PROMs
  • Marks 3–4: Objective examination — Mulder's sign, neurological/vascular screen, differential diagnosis
  • Mark 5: Appropriate investigations (X-ray, USS, MRI) with rationale
  • Marks 6–7: Stepwise evidence-based management (footwear → orthosis → injection → ESWT → surgery)
  • Mark 8: Critical evaluation of evidence, including the Cochrane 2024 review on injections
Gait Alterations (3 marks):
  • Mark 1: Antalgic/guarded propulsive phase with shortened stride
  • Mark 2: Lateral weight transfer and COP deviation with pedobarographic rationale
  • Mark 3: Reduced cadence, gait analysis methods (OGA, pedobarography, 3D capture)
Foot Orthosis Design & Evaluation (5 marks):
  • Marks 1–2: Orthosis specification (material, length, dome positioning — with precise anatomical justification)
  • Mark 3: Rearfoot posting for pronation control and its biomechanical reasoning
  • Marks 4–5: Critical evaluation of effectiveness, evidence limitations, review protocol, and integration into the management ladder

Barriers to communication and solutions In this scenario, the communication with the patient is influenced by multiple barriers which they are presenting with. The patient has a significant sensory barrier, deafness, which limits the effectiveness of verbal communication and requires alternative methods, this can be primarily visual or other methods. The patient also presents with a cognitive barrier associated with the learning disability, which can have an affect on the patients ability to understand, communicate and retain the information provided, especially in the clinical context. Both the sensory and cognitive barrier creates a complex multimodal communication challenge, where both the expressive and receptive communication are impaired. An emotional and behavioural barrier is then present when the patient presents distressed behaviour and withdrawal of the foot, this may indicate fear, pain or a lack of understanding of the assessment being performed. If pain is one of the factors, it further reduces the patients ability to engage, acting as a physiological and communicative barrier as this will increase anxiety and reduce trust. The environmental factors within the home, such as either poor lighting or background distractions, can limit visual communication with the patient. Furthermore, there is a carer present which may introduce potential power imbalances or miscommunicated information, which then may cause the patients autonomy to be unintentionally overshadowed. All of these barriers can have an impact on the treatment/assessment, there can be an incomplete assessment, risk of misdiagnosis/injury and may potentially compromise patients safety. These behaviours are linked and can change, this patient shifted from cooperation to distress, this shows how behaviour is a way of communicating (HCPC, 2023). Failure to adapt communication in such situations risks compromising patient safety and contravenes professional expectations outlined by the HCPC, which emphasises the need of effective communication and meet services users’ individual needs (HCPC,2023). To address these barriers, a flexible and highly individualized strategy of communication must be implemented, aligned with the legal and professional guidance. Initially, the clinician should pause the assessment when the patient becomes distressed, recognising this as a potential withdrawal of consent, and responding in accordance with the Mental Capacity Act 2005, which requires that individuals are supported to make decisions and not subjected to care without appropriate consent (Department of Health, 2005). Communication should be adapted using non-verbal strategies, including gestures, facial expressions and demonstration alongside visual aids such as pain scoring scales or body diagrams to support patient understandings, also if appropriate, a qualified sign language interpreter can be present. Using written communication, clear and simplified language, may also be an appropriate approach depending on the patients comprehension. Making environmental adjustments, such as improving lighting and reducing distractions can enhance visual engagement, whole positioning at eye level and allowing time for processing supports inclusive communication. The SOLER and SURETY models can support effective non-verbal communication in this scenario where verbal interaction is limited. SOLER (Sit squarely, Open posture, Lean forward., Eye contact, Relax) helps the clinician appear attentive, approachable and engaged, which may reduce the patient’s anxiety and distress (Egan, 2014). Similarly, SURETY (Sit at an angle, Uncross legs and arms, Relax, maintain Eye contact, appropriate Touch and using your intuition) promotes trust and equality while encouraging the clinician to remain aware of the patients emotional responses (Stickley, 2011). Using these models can help create a calmer, more supportive environment and improve patient engagement during assessment. Guidance from National Institute for Health and care Excellence highlights the importance of making reasonable adjustments for individuals with learning difficulties to promote understanding and reduce distress (NICE,2018). The carer should be involved, as the carer may be able to keep the patient calm and make them feel more comfortable which also means the carer can aid in supporting communication for the patient. The royal college of podiatry also emphasises the importance of adapting communication and pacing assessments to ensure patient comfort and cooperation in lower limb care (Royal college of Podiatry, 2021). The assessment should be broken down into small steps with regular pauses, which allows the clinician to evaluate the patients response, body language and behaviour, and adjust accordingly. If distress occurs, then the professional can reapproach calmly. This approach ensures the care is delivered in a manner that is safe, ethical and responsive to the patients individual communication needs. - keep this all the same and include in text citations through with Harvard referencing

Here is your text with in-text Harvard citations integrated throughout, keeping all content identical:
Barriers to Communication and Solutions
In this scenario, the communication with the patient is influenced by multiple barriers which they are presenting with. The patient has a significant sensory barrier, deafness, which limits the effectiveness of verbal communication and requires alternative methods; this can be primarily visual or other methods. The patient also presents with a cognitive barrier associated with the learning disability, which can have an affect on the patients ability to understand, communicate and retain the information provided, especially in the clinical context. Both the sensory and cognitive barrier creates a complex multimodal communication challenge, where both the expressive and receptive communication are impaired. An emotional and behavioural barrier is then present when the patient presents distressed behaviour and withdrawal of the foot; this may indicate fear, pain or a lack of understanding of the assessment being performed. If pain is one of the factors, it further reduces the patients ability to engage, acting as a physiological and communicative barrier as this will increase anxiety and reduce trust. The environmental factors within the home, such as either poor lighting or background distractions, can limit visual communication with the patient. Furthermore, there is a carer present which may introduce potential power imbalances or miscommunicated information, which then may cause the patients autonomy to be unintentionally overshadowed. All of these barriers can have an impact on the treatment/assessment; there can be an incomplete assessment, risk of misdiagnosis/injury and may potentially compromise patients safety. These behaviours are linked and can change; this patient shifted from cooperation to distress, this shows how behaviour is a way of communicating (HCPC, 2023). Failure to adapt communication in such situations risks compromising patient safety and contravenes professional expectations outlined by the HCPC, which emphasises the need of effective communication and meet services users' individual needs (HCPC, 2023).
To address these barriers, a flexible and highly individualised strategy of communication must be implemented, aligned with the legal and professional guidance. Initially, the clinician should pause the assessment when the patient becomes distressed, recognising this as a potential withdrawal of consent, and responding in accordance with the Mental Capacity Act 2005, which requires that individuals are supported to make decisions and not subjected to care without appropriate consent (Department of Health, 2005). Communication should be adapted using non-verbal strategies, including gestures, facial expressions and demonstration alongside visual aids such as pain scoring scales or body diagrams to support patient understanding; also, if appropriate, a qualified sign language interpreter can be present. Using written communication, clear and simplified language, may also be an appropriate approach depending on the patients comprehension. Making environmental adjustments, such as improving lighting and reducing distractions, can enhance visual engagement, while positioning at eye level and allowing time for processing supports inclusive communication. The SOLER and SURETY models can support effective non-verbal communication in this scenario where verbal interaction is limited. SOLER (Sit squarely, Open posture, Lean forward, Eye contact, Relax) helps the clinician appear attentive, approachable and engaged, which may reduce the patient's anxiety and distress (Egan, 2014). Similarly, SURETY (Sit at an angle, Uncross legs and arms, Relax, maintain Eye contact, appropriate Touch and using your intuition) promotes trust and equality while encouraging the clinician to remain aware of the patients emotional responses (Stickley, 2011). Using these models can help create a calmer, more supportive environment and improve patient engagement during assessment. Guidance from the National Institute for Health and Care Excellence highlights the importance of making reasonable adjustments for individuals with learning disabilities to promote understanding and reduce distress (NICE, 2018). The carer should be involved, as the carer may be able to keep the patient calm and make them feel more comfortable, which also means the carer can aid in supporting communication for the patient. The Royal College of Podiatry also emphasises the importance of adapting communication and pacing assessments to ensure patient comfort and cooperation in lower limb care (Royal College of Podiatry, 2021). The assessment should be broken down into small steps with regular pauses, which allows the clinician to evaluate the patients response, body language and behaviour, and adjust accordingly. If distress occurs, then the professional can reapproach calmly. This approach ensures the care is delivered in a manner that is safe, ethical and responsive to the patients individual communication needs.
Reference List
Department of Health (2005) Mental Capacity Act 2005. London: The Stationery Office. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents (Accessed: 29 April 2026).
Egan, G. (2014) The skilled helper: A problem-management and opportunity-development approach to helping. 10th edn. Belmont, CA: Brooks/Cole.
Health and Care Professions Council (HCPC) (2023) Standards of conduct, performance and ethics. London: HCPC. Available at: https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/ (Accessed: 29 April 2026).
National Institute for Health and Care Excellence (NICE) (2018) Learning disabilities and behaviour that challenges: service design and delivery. NICE guideline NG93. London: NICE. Available at: https://www.nice.org.uk/guidance/ng93 (Accessed: 29 April 2026).
Royal College of Podiatry (2021) Clinical guidelines for podiatric practice. London: Royal College of Podiatry. Available at: https://rcpod.org.uk (Accessed: 29 April 2026).
Stickley, T. (2011) 'From SOLER to SURETY for effective non-verbal communication', Nurse Education in Practice, 11(6), pp. 395–398.
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