title: Conservative chiropractic management of recalcitrant foot pain after fasciotomy: a retrospective case review.
abstract: OBJECTIVE
  The objective of this study was to describe the safety and potential therapeutic benefit of joint mobilization and manipulation in the conservative management of patients with recalcitrant foot pain after plantar fasciotomy.
  
  
  METHODS
  The study design was a retrospective review of outcomes of 15 patients seen in a multidisciplinary office setting. All patients had undergone plantar fasciotomy within the 9 months before their admission and had developed lateral foot pain after operation. Each patient had exhibited suboptimal improvement with at least a 4- to 6-week trial of nonsteroidal anti-inflammatory drugs, shoe padding, and rest as prescribed by the attending podiatric surgeon. Manual therapy consisted of either grade III or grade IV joint mobilization and/or high-velocity, low-amplitude chiropractic manipulation to the affected joints in the foot and ankle, and home-based exercise. Outcome criteria were empirically defined as significant improvement, moderate improvement, or no change as assessed by each patient based on a verbal rating scale.
  
  
  RESULTS
  There was no long-lasting complication associated with any of the procedures, although a common pattern of transient pain migration over the dorsum of the foot into the ankle was noted in some patients; this resolved by the time of discharge. Of the patients with pain in the calcaneocuboid and/or fifth tarsometatarsal articulation, 11 noted significant improvement, 3 experienced moderate improvement, and 1 reported no change. Patients who complied with home care instructions responded better to therapy in most instances.
  
  
  CONCLUSIONS
  These preliminary findings suggest that joint mobilization and manipulation are safe conservative procedures to use in the treatment of patients with lateral column foot pain in status post plantar fasciotomy.
authors.affiliation: Division of Clinical Sciences, Texas Chiropractic College, Pasadena, Tex, USA. damiantx@earthlink.net
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Wyatt
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal; D036981:Fasciitis, Plantar / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D013640:Tarsal Joints; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal