Case of the Month: January 2011

The Patient

• 63 year old male with a history of diabetes
• Otherwise unremarkable history

The Patient’s Complaints

• Severe left sided heel pain that began 3 months ago, and is made worse by walking and prolonged standing
• The patient to forced to limp when trying to walk
• Occasional left sided knee pain and lower back pain

Snapshot of My Examination Findings

• Patient demonstrates a loss of balance while walking
• Guarding (protective movement and positioning) of the left lower extremity
• Multiple areas of spinal subluxations (jammed spinal bones that irritate the nervous system)
• Painful range of motion of the left hip joint
• X-ray evaluation of the left foot and heel showed only mild degenerative changes (bony arthritis); no heel spur seen
• Extreme tenderness of the plantar aspect (bottom) of the left foot and heel when touched by hand
• Digital and visual evaluation of the arches of the foot revealed a severe arch drop of both his left and right arches

My Diagnosis

• Plantar Fasciitis and Excessive pronation (“fallen arch”) of the left foot
• Lumbosacral area joint dysfunction and pain
• Multiple spinal and left hip subluxations

My Recommendations

• A course of 12 visits of integrative care to include the following:
• Chirporactic adjustments of the spine, feet, left knee, and left hip
• Myofascial release to the feet, hips, and lower back area performed by massage therapist
• Wear custom spinal pelvic stabilizers (orthotic inserts) to support the arches
• Progressive therapeutic exercises targeting the feet and lower extremity, with a focus on restoring normal balance
• Ice the left arch at home as needed for 15 minutes per hour

The Prognosis

• Fair to Good

Discussion

Plantar fasciitis is a fairly common condition that we see in our practice.  It affects the section of soft tissue on the bottom (plantar surface) of the foot.  When the sheath (plantar fascia) of elastic (connective) tissue becomes over-stressed, it can become inflamed and very painful.  The most common problem occurs when the three arches of your foot drop too far or collapse (through time and stress), the plantar fascia becomes abnormally pulled and  stretched out.  This pulling can lead to inflammation and pain in your heel, your arch, and even in your forefoot.  In severe pain cases, a burning sensation can be felt going across the bottom of the foot, and walking would be very painful and difficult.

Upon following our advice and treatment schedule, this patient has had an approximate 75% improvement in 2 weeks of care.  He is virtually pain free and is now able to walk without limping.  The knee, hip, and lower back problems have also shown considerable improvements.

Our Approach To Plantar Fasciitis

If you were a new patient visiting our office, we always start with a thorough case history, consultation, and examination.  I may recommend diagnostic studies (x-ray or MRI) if I need more information. At this point, if I determine that care is appropriate and you decide to begin care, I will design a treatment plan for you.  If at any time I discover something beyond the scope of my practice, I won’t hesitate to contact your primary care provider to discuss a possible referral to another healthcare provider.

We follow a very effective  treatment strategy based on the letters ASR.  They stand for:

• A – Adjust (whole-body adjustment techniques)
• S – Support (spinal pelvic stabilizers and other joint supports)
• R – Rehabilitate (targeted exercise therapy/physical rehab)

My approach that works so well with the spine can be applied to other joints of the body. Virtually every articulation of your skeletal system is susceptible to fixations that can impair function and range of motion.  We have a variety of other treatment options to help you recover quickly and completely.  Some of our other treatment options could include:

• Massage therapy
• Laser therapy
• Electrostimulation treatment
• Home TENS unit
• Therapeutic taping
• Targeted rehabilitative exercises for the feet, lower extremity, and lower back
• Exercise modification
• Home exercise program
• Nutritional supplementation and dietary modification

We don’t want you to have to resort to dangerous medicines, injections, or surgery.  Our approach is to use chiropractic care and other natural therapies (such as massage or rehab exercises) to correct your plantar fasciitis problem quickly and  naturally.