RESUMO
OBJECTIVE: The purpose of this report is to present the case of a 10-year-old football player with bilateral plantar fasciitis who improved with a multimodal conservative approach using chiropractic treatment. CLINICAL FEATURES: The patient presented with bilateral plantar heel pain at the origin of the plantar fascia with a duration of 3 weeks. INTERVENTION AND OUTCOME: Treatment was provided for 6 visits over a 6-week period. Chiropractic care consisted of manipulative therapy, soft tissue therapy, and home rehabilitation exercises. The soft tissue technique (Graston Technique) was performed to the origin of the plantar fascia and the triceps surae bilaterally. High-velocity, low-amplitude manipulation was applied to the restricted ankle mortise joint. After 6 treatments, the patient reported resolution of foot pain bilaterally and improvements in activities of daily livings. Three months later, the patient reported no further complications and the absence of pain. CONCLUSION: This patient with bilateral plantar fasciitis improved after a course of a multimodal treatment approach using chiropractic manipulation and soft tissue therapy in addition to exercise and stretching therapies.
RESUMO
OBJECTIVE: This case report discusses the diagnosis and conservative management of a patient with femoral trochlear dysplasia (FTD) and subacute patellar dislocation. Femoral trochlear dysplasia is characterized by an abnormally shallow trochlear groove. Disengagement of the patella from the shallow femoral trochlea is common in FTD and is a predisposing risk factor to recurrent patellar dislocation and subsequent premature osteoarthrosis. Accurate diagnosis is necessary to prevent recurrent patellar dislocations and damage of the patellofemoral joint cartilage and supporting structures. CLINICAL FEATURES: A 16-year-old male adolescent presented with pain, ecchymosis, and swelling about the right anterior knee approximately one month after a self-described dislocating event. Clinical and imaging findings, including magnetic resonance imaging and ultrasonography, demonstrated evidence of patellar dislocation with previously undiagnosed FTD. INTERVENTION AND OUTCOME: After drainage of the knee effusion at a local hospital, the patient underwent a chiropractic treatment protocol consisting of stabilization with patellar tracking orthosis, customized orthotic support, and various muscular stabilization and strengthening exercises. After 6 weeks of treatment, the swelling and ecchymosis resolved. The knee ranges of motion were full without pain. Although the hypermobility of the patella demonstrated no interval change, the patient reported improved strength and stability of the right knee. CONCLUSION: This case highlights a young athlete with subacute patellar dislocation and FTD who responded successfully to conservative management. Conservative stabilization and strengthening protocols improved patient outcome without surgical repair of the underlying FTD. Conservative management of FTD has not been reported and it makes the current case unique. However, the long-term outcome of conservative management is unknown at this point and further studies are necessary to evaluate treatment protocols.
