Chiropractors sometimes recoil and the sight of treating a Retrocalcaneal exostosis or Haglund's deformity. What they are essentially are is a growth on the posterior portion of the heel where the Achillies Tendon inserts into the Calcaneus. They can be extremely painful and ruin shoes. This video here explains the condition very well:
Now the first thing one should do as with most treatments chiropractor's perform is it to start the patient on stretching exercises, a great deal of pain can be caused by the Achillies just being tight, by stretching out the Achillies you may reduce the pain. Here are some stretching exercises. (above)
Now after you perform that the next thing is to address the etiology of the pain, which is caused from the bump on the patients heels rubbing against the back of the shoe. One of the simple treatments is to insert a heel lift into the patients shoe as seen here
After that if that is not successful is get the patient into some crocs, by taking away the back of the shoe, that will take away the etiology of the pain and will allow you some residual income. You can even have a croc display to sell to your patients. Crocs are a revenue sources that no Chiropractor should be without, here is an example, if you mark these up just 5% it should help with revenue
I hope this helps Chiropractors in their treatment of Retrocalcaneal exostosis.
There are many things that Chiropractors can use in addition to Night Splints by patients for Plantar Fascitis. An Arch pad is something that wraps around the foot and supports the plantar fascia during gate can be used and give relief from Plantar Fascitis. These tend to be inexpensive and widely available, as seen here:
One can offer these to a patients for under ten dollars and still make a profit.
What can you do in the office what exercises and equipment can you use in your office. There are multiple options and equipment, you can use. This equipment all works the same way by strengthening and extending the plantar fascial ligament.
As one can see there are many options for the Chiropractor who is treating plantar fascitis to use and no reason, that a chiropractor can not be successful in treating plantar fascitis.
So, you have tried orthotics, advil and stretching for plantar fascitis or heel spur syndrome with little to no success with the patient. If you are out of idea consider the use of a Night splint to help with the plantar fascitis. Night Splints are inexpensive and occasionally covered by insurance. The night splint holds the plantar fascitis at ninety degrees, thus relaxing the ligament and stretching the ligament to help with the discomfort. These tend to have a great deal of success and there are multiple brands of plantar fascitis. As said you can bill the insurance of the patient for 5-10 dollars over cost.
So, you are a Chiropractor, you advertise that you treat the foot and ankle. but, you secretly pray that no patients come in with foot and ankle maladies. That can be corrected, there are multiple foot and ankle deformitites that a Chiropractor can treat with little to no problem. The first and most obvious of this is plantar fascitis. Here are the signs of Plantar fascitis: http://www.mayoclinic.com/health/plantar-fasciitis/DS00508/DSECTION=symptoms
Essentially, your patients will state that after sleeping or sitting for awhile, their first step hurts with a stabbing sensation. You can take X-Rays of the Foot and Ankle as most insurances will cover those. If you see a spur, you can mention it to the patient. But, there is little scientific literature that indicates that the heel spur has anything to do with the plantar fascitis. Treatments for plantar fascitis range from cortisone shots to oral steroids and those tend to be effective but the first thing you should advice your patient on is stretching exercises demonstrated here:
These are simple to perform with wonderful success. However that does not make you much money, a lot of people consider orthotics to be a gold standard treatment of plantar fascitis because, the condition tends to be cause by a biomechanical abnormality. I do not know how much experience a Chiropractor may have with custum orthotics. If you have limited you may consider, simple over the counter orthotics like:
Sell either the Powerstep or the Spenco at a 5 to 10 dollar markup over your cost. Be sure to have the items in stock for most sizes. Patients tend to be relieved that they do not have to spend over 250 dollars for a custum orthotic, some people charge as much as 400 dollars. It is a simple way to make a profit. Note none of the prefabricated orthotics will be covered by insurance. However, a lot of private insurances and the occasional public insurance do cover custum orthotics. The great thing about Custom Orthotics is you do not need a two thousand dollar gait scan or cast to make them/. The chiropractor can make custom orthotics safely and cheeply utilizing inexpensive biofoam boxes. As demonstrated here
Once you have the impression send it to an orthotic lab of your choosing. Try to utilize a lab that is located close to your location. Here is a place to purchase biofoam
So for a simple 15 dollar charge to you, you can then bill out a costum orthotic for as much as 200-300 dollars as well as give your patient a great deal of relief. My next blog will focus on physical therapy as well as DME treatments available for the Chiropractor in treating Plantar Fascitis.
