Chiropractor's Guide to treating an Ankle Sprain by a Podiatrist

Chiropractors should not fear ankle sprains.  99% of ankle sprains are self limiting and will get better regardless of the treatment that is rendered.  The Chiropractor approach to the ankle sprain should be about treating the acute injury and then strengthening the effected ligaments via Physical Therapy.

An Ankle sprain's initial presentation generally are from a sporting event such as basketball or soccer.  The player cuts and turns his ankle.  Generally the ankle will appeared swollen with possible discoloration.  Purple discoloration does not mean that the ankle is fracture it only means there has been some trauma to  the area.  Initial treatment of the sprained ankle should include ankle X-rays.  If you are not confident in reading Ankle X rays to check for fracture, you should not be treating ankle sprains, refer them to a podiatrist.  Other signs that would indicate fracture are extreme pain and the complete inability to place weight on the effected extremity.  Following that a Chiropractor should palpate the ankle ligaments, with specific attention paid towards the Anterior Talo Fibular Ligaments and Calcaneofibular ligaments, those are the two most likely to be torn.  A torn ligament does not require surgery it is a normal pathology present in an ankle sprain.  Here is an example of an Ankle Sprain examination:

Following the exam the first treatment of an ankle sprain, is to have the patient initiate the RICE formula, which means Rest Ice Compression and elevation all of which can be accomplished easily.  Here are some products you might stock to help the patient, most of these insurance will not reimburse for:

Following that the goal is to reduce the swelling, the Chiropractor should not perform physical therapy while the ankle is still swollen.  The swelling will generally reduce in 48-72 hours post injury.  But to be safe wait a week before being the ankle physical therapy.  Prior, to the Chiropractor beginning Physical Therapy, he should place the patient in an ankle brace of some make, in order to give compression and support to the injured ligaments.  Some of these braces are reimburse from insurance greater then 100 dollars.  Here are some examples:

In addition to the brace, the Chiropractor at this time should begin Physical Therapy and the sprained ankle as demonstrated here:

Now if after 4 weeks the patient still complains of pain at the time the Chiropractor should refer that patient to a Podiatrist.  As other issues may be going on with the patient such as an undiagnosed fractures, or ligaments that need to be surgically repaired.

A Guide to Chiropractors who treat Diabetic Neuropathy by a Podiatrist

The question is should Chiropractors treat Peripheral Neuropathy that is metabolic in nature and not occurring due to a spinal deformity.  These type of Neuropathies would include Diabetic, Cancer, Syphilis, Vitamin deficient or Alcholic Neuropathy.  All those conditions arise from a metabolic condition in the body that no spinal adjustment with correct.  Is there anything a Chiropractor can do for Diabetic Peripheral Neuropathy? The answer is yes and no.  The only proven treatments for Peripheral Neuropathy are drugs such as Lyrica, Cymbalta or Neurontin.  So when the patient presents the first question should be; have they tried these medications, and if the answer is no.  The patient should be referred to a Podiatrist or PCP so they can get on these medications.  However, that does not mean adjunct treatments cannot be performed in the mean time to help the patients.  Additionally, when the patient is on the medications, the Chiropractor can offer other treatments to help relieve the symptomatology of painful Diabetic Peripheral Neuropathy.  For further information on Peripheral Neuropathy, the Chiropractor may want to read the following books:

Now the first treatment, the chiropractor should start with is physical therapy, or stretching for the Neuropathy.  One of the worst problems that develops with neuropathy is an atrophy of the legs, due to the pain and not walking.  So any exercises and movement for the patient who suffers from Neuropathy is a positive.  Here are some examples of possible Neuropathy exercises to be performed:

Now another treatment that does under physical therapy is Anodyne treatment for the lower extremity.  Anodyne is not covered by Medicare but can be billed under a physical therapy code.  Anodyne has been shown to demonstrate improvement in the Neuropathy symptoms.  Anodyne is simply lasers directed at the feet to warm them an increase sensation as seen here;

The machines are not that expensive anymore, and they do require the patient to come in for regular treatments.  Here is a machine that only retails for about 130 dollars so after one patient and eight treatments, you will already be making a profit.


Another option for treating Neuropathy would be to sell a patient, vitamins to help suppliment their treatment.  Regardless of what you have heard there no facts, that vitamins are successful in the treatment of Neuropathy.  That does not mean they cannot be tried and sold to the patient for a reasonable profit.
Here an example of a few vitamins you can offer to patients:

Chiropractors Guide to Treating Achillies Tendonitis

Achillies Tendonitis should be a natural condition for Chiropractors to treat, but for some reason they get nervous and the term "achillies".  There is no reason to be.  Achillies Tendonitis is a simple condition that almost always responds to conservative treatment.  The presentation of Achillies tendonitis is pain on the posterior portion of the heel where the Achillies inserts into the Calcaneus.  The patient will often complain of difficulty and aggravation in the Achillies when climbing hills or descending hills or stairs.

Upon presentation to the Chiropractor it will be important to get them on some kind of anti inflammatory such as Motrin or Ibuprofen.  Then begin a stretching regimen such as above.  Then you will want to get the patient into a heel lift of some sort they can generally be purchased and then re sold to the patient for a small profit, such as these
Personally I would purchase the Spenco brand for Achillies Tendonitis.  If this is unsuccesful in treatment send them for an MRI, and if it does not further respond.  Then refer to a Podiatrist for further intervention, but the key here is that 90% of Achillies Tendonitis will resolve with simple conservative treatment as listed above.