Case reportChiropractic management of pediatric plantar fasciitis: a case report
Introduction
Musculoskeletal pain is a frequent complaint in childhood, affecting 7% to 15% of school-aged children.1, 2, 3, 4, 5 Of the children affected with musculoskeletal complaints, 28% have a mechanical overuse etiology (chondromalacia patella, mechanical plantar fasciitis, tenosynovitis, muscle pain).1
Plantar fasciitis or heel pain is a commonly seen condition and can occur among all age groups, sex, ethnicity, or activity levels.6, 7 It is most frequently seen in overweight male runners (body mass index >25 kg/m2) older than 30 years. Although plantar fasciitis occurs most commonly in the adult population, a study of 1000 consecutive pediatric musculoskeletal cases presented this condition as having a prevalence of 8.2%.1 Plantar fasciitis is considered to be an overuse syndrome. It develops over time, and repeated stress likely plays a role in the etiology. As this stress compounds, it will exceed the body's inherent capacity to repair and adapt, which eventually leads to the failure of ligaments, bones, and muscles.5
In young athletes, plantar fasciitis usually corresponds with calcaneal apophysitis and rarely exists by itself.8 The calcaneal apophysis serves as attachment for the Achilles tendon superiorly and for the plantar fascia and the short muscles of the sole of the foot inferiorly.8, 9 The os calcis (calcaneus) secondary center of ossification appears at age 9 years and usually fuses at 16 years old. Pediatric athletes with closed physes will typically present with medial arch or heel pain.8, 10, 11 Symptoms of plantar fasciitis most often occur during weight bearing and may be exacerbated by climbing stairs or weight bearing on dorsiflexed toes. Morning foot pain and stiffness are an additional common complaint. Inflammation is usually secondary to repetitive stretching of the plantar fascia between its origin at the anterior plantar rim of the calcaneus and its insertion into the metatarsal heads. Tenderness is most commonly palpated along the medial edge of the fascia or at its origin on the anterior edge of the calcaneus.8, 11, 12 Activities such as jumping, hill running, or speed work may predispose athletes to a higher risk of developing plantar fasciitis.8, 10, 11 Various anatomical factors such as pes cavus or varus hindfoot may also put the athlete at risk.10
Plain film radiography typically does not contribute to the diagnosis of plantar fasciitis. Heel spurs may result from this condition; however, spurs are not recognized as the likely pain generator.11, 13 Treatment of plantar fasciitis in young athletes commonly includes any of the following: rest, ice, Achilles tendon stretching, heel cups, nonsteroidal anti-inflammatory drugs, correcting training errors, orthotics, and steroidal injections.10 Surgical plantar fascia release may be used in extremely complicated cases.12
To our knowledge, only one study has discussed the use of Graston Technique (GT) (Fig 1) in a multimodal approach to plantar fasciitis; but no studies have addressed this approach in the pediatric population.14 Therefore, the purpose of the study was to describe a multimodal approach to the management of plantar fasciitis in a pediatric patient using Graston instrumented-assisted soft tissue technique, chiropractic extremity manipulation, and an exercise protocol.
Section snippets
Case report
A 10-year-old little league football player presented to the clinic at the Logan College of Chiropractic. At the time of the examination, he was 129 lb and 5′1″ tall (body mass index, 24.4 kg/m2). His chief complaint was bilateral plantar foot pain of 3 weeks' duration. The onset of symptoms began at the start of his football season. His football position was lineman; and inherently, he spends the majority of time pushing forward against an opponent weight bearing with his metatarsophalangeal
Discussion
The differential diagnosis in plantar foot pain includes plantar fasciitis, stress fracture, sesamoiditis, bursitis, Achilles tendinopathy, tarsal tunnel syndrome, lumbar radiculopathy, and systemic metabolic conditions. Therefore, a thorough workup of the patient with plantar foot pain, including careful neurological examination and assessment of the lumbar spine and lower extremity and its related muscles, is indicated.
Despite plantar fasciitis being a relatively common disorder, little is
Limitations
Lack of objective outcome measurements throughout the case is a fault of this report. Recognizing the natural history of plantar fasciitis, it is possible that the patient's outcome was due to spontaneous remission and not the intervention that was provided. The treatment of this case was multimodal; there is no way to determine the extent to which any individual treatment modality may or may not have contributed to the perceived beneficial outcome. The findings from one patient may not
Conclusions
The case report describes a conservative approach for the management of a pediatric patient experiencing plantar fasciitis. In this patient's case, the combination of joint manipulation, GT, and a targeted home exercise program seemed effective.
Funding sources and potential conflicts of interest
No funding sources or conflicts of interest were reported for this study.
Acknowledgment
The authors thank Dr Miranda Davis, DC, for her contribution to this manuscript.
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