I have a new patient, 21yo Female. College athlete, who injured her foot 6 years ago in HS. I wrote up the intake below and tried to breakdown my thoughts, however I would love to hear other’s insights on what else I am missing and how to get this fully resolved. TIA
CC: Chronic foot pain in left foot, ongoing for 6 years
Her words: "I’ve had to give up running, playing sports, jump roping, crossfit, hiking, and all other exercises that require repetitive movements with high impact on the ball of my foot. *
Unfortunately, all of those exercises are my favorites. I don’t particularly like lifting, I just do it because it is all I can do without being in excruciating pain.*
Sometimes I still try to run and play sports because I miss it so much, only to be in extreme pain that will last for the next week straight. I’ve kinda just learned to suck it up, but some days I can’t push through the pain. *
Over the 6 years, my pain has continuously gotten worse. Now, I can barely walk barefoot around my house, I can only wear sneakers and certain boots, I always have to wear orthotics, and it is painful doing day to day activities on my feet. *
8 different doctors, x-rays, MRIs, steroid injections, ultrasounds, vascular tests, nerve tests, exertion compartment pressure tests, massage therapists, still no answers. My current doctor wants to schedule surgery to remove the nerves in my feet but I’ll lose feeling. It feels like I’m constantly going to see a new doctor only to be told “everything looks normal.” Some doctors even recommended pain meds which is a big no no for me. My spongy tissue in the ball of my left foot is literally deteriorating every day."
Pain started in HS while playing basketball and running during soccer. She has been able to do more on it lately, over the last few years and even ran a virtual marathon in Nov with no training. However it has gotten so bad she has stopped all running, she is fearful and stressed about this.
The pain is on the ball of the foot, just under the second toe and travels up into the tip of the toe. Nothing recreates the pain except weight bearing activities. Pressing really hard on the bottom of the foot can cause some recreation, but not like it feels when she stands on it. Can’t stand on toes.
in HS she used to take her shoes off when she would have to do longer runs for soccer because of the pain.
- COLD All over Body, +6
- Cold hands and feet; Feet more then hands +6
- Sleep - gets 9 hours and is rested when she wakes
- Self Image/Identity: Athlete, this is her Identity: She is a personal trainer and life coach, started her own business with COVID. She works out multiple days a week and is highly motivated to feel good and stay healthy. She was a college athlete and was captain of her Soccer and Basketball teams in HS. Played basketball in college.
- Muscle Tone: +2 She is still a very fit athlete, muscles are strong and healthy, not dense. Tone and pliable, nothing feels overly tight on her.
- Thirst: normal, stays hydrated
- Psychoemotional: Anxiety +5, when she doesn’t work out she gets anxious, “as a child she had to be the best. Graduated #1 in class, captain of every sports team, work harder then everyone else.” She did not “chill out” until college. Parents divorced at an early age and being the best brought her positivity from her parents +7
- GYN: Menses age 13, (Feels like that was late compared to friends, also didn’t have a growth spurt until 14, was shortest for years in her class)
- Medial Heel-Normal
- CV - normal, same temp as rest of abdomen, firm-same as rest of abdomen
- Varicosities - none
- LU 10 - normal, not hard or puffed out, not sunken in either
- -Skin - normal, does not use lotion. no cracking, pinch test reveals normal skin no flaking or cracking
- -Eyes - +4 bright, but not excessive
- -Bone structure - normal, balanced in face
- -Good Reporter
- Well Groomed +6, promotes her business on Social media, so she is constantly putting herself out there and cares about her image/brand
- Can not slow down +9, if her schedule is not busy she is not happy
- Chest puffed out- +7 Her R. Rib cage developed larger then her L. Side. MDs thought this may be a result of the way she was held as a baby, but her parents reported alternating her feedings and doing all the tummy time and other normal positioning for a baby. When she was younger they did X-rays and monitored the growth, it seemed that more bone and cartilage formed on the R. Side under the breast bone pressing her R> rib cage out almost two inches further the the L.
- Acid Reflux- +8. When this started at the age of 14 she had horrible acid reflux, when she was a baby she was not able to hold down milk or formula, she would projectile vomit, at age 7 she had st issues.
ST+ on R
After 20minutes she got off the table and walked on her foot with no pain, she asked if she could try to stand on her toes. She did and had no pain.
She had no pain for about 24 hours, then the pain came back as an 8/10 and the next night her acid reflux was horrible.
The 2nd day after treatment when she woke up she walked on her foot and it was a 3or4/10. And the acid reflux has only acted up once more over the last week when she ate something that usually triggers her acid reflux. Her pain stayed in the 3/4 range for the entire week. She tested it and did some light cardio but did not push it for long periods of time. A 3/4 is the lowest it has been in years, so she is happy but would like more pain to go away.
She has also been able to pinpoint the exact spot of pain, it is in the ball of the foot at the base of the second toe and when it flares it shoots to the tip of the second toe. (The pain is on the lateral side of the toe only)
Sp+, the pain was back to a 0/1 in the ball of the foot, but she still had a sharp feeling in the tip of the toe.
I looked at this as possibly going back to her early childhood with the projectile vomiting from her infant days, then her stomach issues manifested at age 7 and again at age 14 in HS, then at age 21 it flared again. So my first treatment I treated the acid reflux symptoms from when her foot started at age 14, even though she said she can control her acid reflux with diet and lifestyle, it can flare in an instant. All the pain is along the ST CH. I am not sure if I saw a ton of LU excess evidence, besides the flaring of the R. side of her chest and I wasn’t sure if this is considered a Kid sign or a Lu sign.
Second treatment I went with Sp+ because she can’t stop going, she won’t rest her foot and even ran a virtual marathon on it in the Fall because she felt like she had to honor her father’s friend who died in 911. Her father is a state trooper. She also revealed that since her foot is feeling better she has started to go to Crossfit.
When I did the SP treatment she settled in and it helped, but I don’t think it had the same massive change as the ST+ treatment.
I have only seen her twice and she is on a 1/week schedule.
I am trying to decide if I should go back to ST next session or look at KD, LV or HT.
I appreciate any thoughts that can be offered on this case.