Chronic Foot Pain from Osteoarthritis and Multiple Metatarsal Fractures Relieved in 1 Treatment
Client Info
Age: 33
Occupation: Forestry Management
Exercise / Type and Frequency: walks dog 3 x daily
Currently Receiving Treatment from Another Health Care Provider: Medical Specialist informed patient that he could no longer do anything for their condition.
Reason(s) for Seeking Treatment: Diagnosed with osteoarthritis pain in both feet and ankles. Patient had pain in both feet for months, and kept going to the doctor. X-rays did not show anything out of the ordinary. Eventually with persistence the patient was sent to a specialist who did imaging with die. The patient had fractured the 3rd metatarsal. However, the factures happened to both feet multiple times. Each time the cast came off one foot, the other foot fractured, and this repeated back and forth several times over a period of 8 months. At the last check-up the doctor reported that the fractures in both feet had healed. However the patient was still in constant pain.
Frequency / Onset: Pain when sitting and not weight bearing on feet 2-3 (scale 0 = no pain and 10 = maximum pain), when standing 3-4, walking 4-6, when walking on uneven surfaces or when raising up onto her toes to reach for something pain increases to 7-8 ("sometimes the pain takes my breath away"). When attempting to rotate the ankles, the right ankle is painful, but not the left.
Injuries or Motor Vehicle Accidents & Dates: none
Surgeries & Dates: Appendix removed at age 5.
1st Appointment
Tests:
Range of Motion (ROM) normal on both feet in plantar and dorsi flexion.
Manual pressure on dorsal surface of all 5 metatarsals (+) produced pain, however more intensely on the 3rd metatarsal.
Manual pressure on plantar surface of all 5 metatarsals (-) produced no pain.
Manual pressure on posterior surface of right and left calves (-) produced no pain.
Manual pressure and mobilization of right fibular (+) produced pain, no pain on the left.
Manual pressure along length of Tibialis Anterior muscle (+) produced pain.
Manual pressure on right and left sacroiliac joints, and on posterior surface of sacrum (+) produced pain.
Treatment Techniques:
Prone:
Myofascial Release of lumbar right and left paraspinal muscles
Myofascial Release of gluteal and right and left piriformis muscles
Myofascial Release of right and left iliotibial tract
Myofascial Release of right and left calf muscles
Mobilization of Sacroiliac joint.
Counterstrain of sacral Tender Points (Tp’s)
Supine:
Myofascial Release of lumbar right Tibialis Anterior muscle and interosseous membrane.
Muscle Energy Technique Post Isometric Relaxation (PIR) of Right Fibular Head.
Harmonic Oscillation of lower extremities along coronal plane.
Result: patient reported complete relief of pain immediately following treatment in sitting without weight bearing, standing and walking.
Home Care Exercise: Structural Alignment Yoga Therapy - Foot Work, and Heel-Toe Raises to stretch plantar surface of feet and calf muscles.
* Therapists' Note: This exercise is covered in my Structural Alignment Therapy Training, among a long list of amazingly effective exercises for various conditions. This cient has not needed any follow up appointments because she was taught how to adjust and strengthen her posture in a way that no longer causes her pain. Learn more >>
2nd Appointment pending...
Follow up appointment is scheduled. At that time we will determine if pain relief was permanent or if further treatment is required.
Clinical Impression
The two key points in the success of the first treatment were:
1. When I asked the patient what different positions or activites cause pain, and what the level of pain is at these different times, the patient said that raising up on the toes increased pain. This revealed that the sacrum was involved via nerve root dermatomal correlation. Asking the right questions during the patient history is key!
2. When the patient reported that the right ankle was painful during rotation, I suspected involvement from the leg; sure enough the right fibular head tested positive and needed adjustment.
Therefore, the residual pain in the metatarsals was a symptom of myofascial imbalance from the sacrum and lower extremities, and not the cause.
