Orthotic Case Study to Relieve Pain from Flat Feet in a 23 Year-Old Nurse
By Dr. Ryan Zullo, DC
Have you ever had a patient walk into your office and you instantly say to yourself "Oh wow, they are in a lot of pain"? I said those exact words to myself recently as I saw one of our Chiropractic assistants walking a 23-year-old female back to the consultation room.
I had noticed that she was bent over at a 45-degree angle from the waist, shuffling her feet, and moving at a pace that was clear that she had to consciously think about each and every step she made in order to manage the pain. As I’m about to open the door and greet her, I thought I knew exactly what her chief complaint would be... I was wrong.
I walked in, introduced myself, and after confirming she was comfortable, I asked her "what brings you in today?”. Fully expecting to hear "I hurt my lower back" she immediately shouts "MY FEET! Not my back, the pain is in my feet!" Her eyes began to tear up and she went on to say that there wasn't any acute trauma. She just went to bed one day after her shift and when she woke up and got out of bed to start her day, she instantly felt sharp, stabbing, almost “brings you to your knees” pain in the bottoms of both feet.
As a nurse, she is on her feet for most of the 8–10-hour shift lifting, moving, and helping take care of others. Unfortunately, the repetitive stress to her own body has caused her to reach a point where she is forced to now take care of herself. As we went through her health history I asked if she had an exercise regimen, or if she played sports in High School or college and she stated that she was a big runner. "Hurdles was my main event" and then started laughing, saying "Well no wonder why my feet hurt... I didn't even think about that". Playing sports all her life, there was definitely a lot of "wear and tear" on not only her body, but her feet as well.
Her Pain Was from Flat Feet
We continued on to the examination room in search of a diagnosis. As she was supine on the table, the natural position of her feet was in dorsiflexion. I instantly noticed how flat footed she was and upon standing barefoot, how she naturally stood on the outside portion of her feet. This could have been because she was in pain and trying to compensate, but she confirmed that she has stood like that for years “It just feels right. But it’s funny that you say that because my mom always told me I was flat footed”.
Due to the lack of arch in her feet, I asked her about insoles. Has she ever had them? If so, does she continue to use them? Her response was a quick "Yes and they didn't work... but I still keep them in my shoes". I performed the shoe evaluation, there wasn't any significant wear pattern on the bottom of her shoes, so I decided to pull out her insoles. I noticed that the animal printed insoles were just rubber. No part of the insole had extra material that would be hard enough to provide support to any of the arches in her feet, just perhaps a little extra cushioning.
To rule out any underlying trauma elsewhere, X-rays of her Lumbar spine and pelvis were taken in addition to her feet. Films did not reveal any significant findings in the anatomy of her feet, but she did present with a mild to moderate "S" curve in the thoracolumbar spine measuring 12.5 degrees and 8 degrees respectively.
It would not be uncommon during her shift that she'd have to remove her shoes and massage her feet. In fact, this was happening every few hours. She had to sit down, remove her shoes and dig her thumbs into the bottoms of her feet in hopes to release some of the tension just to be able to get through the rest of her shift.
Her Flat Feet Pain Was Relieved with an Orthotic Insole
After considering what was discussed in the consultation room, reviewing the results of the Chiropractic examination and X-rays, I had recommended a program of care that not only included addressing the “S” curve and her pelvis, but adjusting her feet as well. I also recommended PowerStep insoles while she is working to not only help hold the adjustments, but to begin to train the body to be in better alignment. She slipped the insoles into her shoes and we proceeded with the adjustments of her spine, pelvis and mobilization of both feet.
She was both nervous and excited and there were definitely some ooo's and ahh's during the treatment. She left my office that day still experiencing some pain and discomfort, still shuffling her feet, but she was more upright, she was walking a little bit faster, and the grimace on her face wasn't as intense with each step. After scheduling her next appointment and about to head out the door, she turned back with a smile and told me "I instantly feel a little bit better".
Upon returning to the office, just two days later, she was so excited to share with me that since her last treatment, she worked an 8-hour shift with only mild discomfort! She also went on to say that her activities of daily living were instantly improved. Things like sleep, standing to wash the dishes, walking around the grocery store, and every duty that needs to be performed at work was easier to perform.
Fast forward two months and 15 visits later and she still can’t believe how much better she feels. She continues to wear proper footwear with her insoles, even when she’s not at work, continues to be aware of her posture, continues to perform stretches from her home exercise program and is scheduled to come back to the office in 4 weeks for a maintenance adjustment to her lower back, pelvis and feet.
The point of this article was to create awareness. As a Chiropractor, we are here to help people, to guide them, and most importantly, make them feel comfortable. By taking my time, asking the right questions, listen to her answers, she put her guard down, got over her anxiety and trusted me to do what I do best. The end result was truly life altering and I am so happy to be a part of that.