Editor's Note: The following is the third of three case studies by Dr. Wong on conservative management of lower-extremity complaints. Article #1 (September 2018 issue) discussed chiropractic management of patellofemoral arthralgia; article #2 (November 2018) explored osteoporosis and the role of orthotic support.
History & Subjective Complaints
Patient presents with a history of forefoot pain. Discomfort has become worse in the past six months. He has difficulty completing his four-hour shifts as a part-time hairdresser. The patient has become accustomed to taking an analgesic in the middle of his shift to combat pain (this dulls it somewhat, but makes him feel "foggy"). He is concerned about dependency.
Objective Findings & Vitals
The patient is an African-American male, 37 years old. Height: 6'2". Weight:190 pounds.
Objective Orthopedic and Neurological Findings
A marked reduction in height of the longitudinal arch is noted; severe forefoot pronation. A hallux valgus is in the early stage of development. Forefoot discomfort worsens with prolonged weight-bearing. Examination of footwear shows excessive wear patterns consistent with excessive pronation and forefoot loading. Slight posterior lower-body muscle tightness including tightness of calf muscles, limited ankle dorsiflexion and ankle joint laxity. Neurological exam reveals normal responses to dermatomes, myotomes and deep tendon reflexes.
Radiology
No abnormalities detected.
Working Diagnosis
Metatarsalgia caused by overpronation.
Treatment Plan / Recommendations
Discussion and Response to Care
“Metatarsalgia" – literally “pain in the metatarsal area" – is most useful when thought of as a description, rather than a diagnosis. A thorough assessment must be undertaken in order to address all causative factors. Vascular, metabolic, rheumatic, and even neurologic and psychogenic diseases must be ruled out in initial assessment before recommending treatment.
In this patient's case, custom orthotics paired with at-home exercises, stretches and the use of better footwear resulted in a significant decrease in pain. After two weeks, the patient was able to complete his shifts without pain medication.
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
