Resident Physician University Hospitals Geauga Medical Center Chardon, Ohio
Introduction: Although peroneal tendon tears are common, there is little research on the long term success of surgical intervention and no research to date on how osteopathic manipulative treatment effects the functionality of these patients when used post operatively . This case is of particular interest because not only has the patient involved, undergone surgical intervention, but also has an underlying congenital pes cavus of the injured foot. By exploring the response to OMT in a patient who had both surgical intervention and congenital abnormality, we can gain more guidance in how osteopathic manipulative therapies can be useful in regaining functionality post operatively in leu of other more invasive options.
Case Study: We present a case of a 66 year old female with a history of right congenital pes cavus and right peroneal tendon tear following a traumatic right tibia fibula fracture, confirmed by imaging studies. After initially failing conservative management with physical therapy, surgical reconstruction and debridement were performed. In the months following surgical intervention patient reported significant difficulty with ambulation secondary to decreased range of motion and weak eversion, with physical therapy and bracing leading to minimal improvement. Frustrated, with lack of improvement, patient wanted to explore osteopathic treatment modalities. Patient was treated in clinic, at five months post surgical intervention, with muscle energy and lymphatic techniques every other week for six weeks. Patient reported significant improvement with ambulation and general functionality following manipulation, that she had not experienced prior to treatment. Prior to initiating treatment, thorough review of records in EMR was performed.
Discussion: The patient' improved functionality following manipulation over the course of treatments shows how not only structure and function are reciprocally related, but also shows the body's ability to self heal, encompassing the overarching tenants of osteopathy. Although peroneal tendon tears are common, there is little research on the long term success of surgical intervention and no research to date on how osteopathic manipulative treatment effects the functionality of these patients when used post operatively. Moving forward, the same treatments could be carried out on other patients with areas of dysfunction to improve functionality without additional surgical intervention or pharmacological management. This case study shows that improved functionality, and patient reported satisfaction can be obtained without additional surgical intervention and pharmacological intervention in the appropriate settings.
