Introduction: This paper reports on a 47-year-old Caucasian female who presented to a chiropractic college teaching clinic with pain and unresolved functional deficits from an untreated traumatic calcaneal fracture of 10 years duration diagnosed by radiograph.
Case Presentation: The patient had altered gait, range of motion deficits in the right ankle, hypesthesia and weakness in the right lower leg, and sacroiliac joint pain provoked with lumbar ranges of motion and orthopedic testing. The chiropractic diagnosis was traumatic right ankle arthropathy, pain in the right ankle, myalgia of the right lower extremity, as well as lumbosacral joint dysfunction.
Intervention and Outcomes: Conservative treatment included chiropractic manipulation of the lower extremity and lumbosacral spine, acupuncture in the right ankle region for pain control, soft tissue techniques including myofascial release and instrument-assisted soft tissue mobilization, adjunctive therapies (heat, interferential current and ice massage) and rehabilitative exercises. Outcome measures included the numerical rating scale (NRS) for pain, the Lower Extremity Functional Scale (LEFS), and the Revised Oswestry. The patient attained clinically significant improvement in her NRS and LEFS scores.
Discussion: Untreated traumatic structural changes in the calcaneus can produce chronic pain, inflammation and adhesions along with restricted movement resulting in arthropathy. A combination of conservative therapies and rehabilitation was successful in reducing functional deficits and pain in this patient.
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