Presentation of a Lisfranc Injury to a Chiropractic Clinic: A Case Report.

Objective: The purpose of this report is to describe the presentation of a patient with a previously undiagnosed Lisfranc injury to a chiropractic practice. Clinical Features: A 56-year-old woman presented to a chiropractic clinic with traumatic right midfoot pain 6 months after her injury. She previously jumped out of bed, landing with her ankle inverted and causing severe pain. Before visiting the chiropractor, she saw 2 orthopedists shortly after onset and was told the imaging was normal; medicine and exercises were prescribed. Chiropractic examination found swelling of her foot, loss of sensation, and reduced and painful ankle range of motion. Radiographs revealed widening of the Lisfranc joint with lateral offset of the base of the second metatarsal. Intervention and Outcome: The patient was referred for orthopedic consultation and underwent fusion of the first and second tarsometatarsal joints and the Lisfranc joint. After surgery, she was able to walk indoors unaided and outside with a walker. She reported 13 months later that she was able to walk 3 miles pain-free without assistance. Conclusion: A Lisfranc injury was correctly identified after a thorough examination and radiographs. This case exhibits the importance of chiropractic practitioners understanding and being able to diagnose this injury, which aids in early and accurate assessment with appropriate referral.

Early-Application Extracorporeal Shockwave Therapy for Plantar Fasciitis in a Chiropractic Clinic: A Case Report.

OBJECTIVE: The purpose of this report is to describe the successful management of plantar fasciitis (PF) using only extracorporeal shockwave therapy. CLINICAL FEATURES: A 26-year-old male former athlete presented with insidious right posterior medial foot pain of 3 months' duration. He reported a past history of similar symptoms 12 years previously and was successfully treated with tape, ice, and electric stimulation. For the current episode, he attempted to manage with orthotics, motor nerve stimulation, and ice, and when that was insufficient, he sought care in our clinic. Initial history and evaluation found provocation of pain and functional limitations while wearing dress shoes, running, and playing basketball. Examination found palpatory tenderness at the medial aspect of the distal right calcaneus, and pain with right ankle dorsiflexion. Radiographs were unremarkable. Patient presentation and exam findings supported a working diagnosis of PF. INTERVENTION AND OUTCOMES: Treatment was applied with a Richard Wolf WellWave low-energy shockwave therapy unit with focused dosage of 4000 shock pulsations at 10-mm depth to the site of pain. Treatment was applied 11 × over 5 weeks, after which the patient reported a complete resolution of pain and resumption of all activities. CONCLUSION: Extracorporeal shockwave therapy appeared to be an effective treatment approach for the management of this patient's PF.