Intriguing Chiropractic Cases: Foot, Knee, Tibialis Pain Analysis
On this episode of Week in Review, The FARM clinical team dives into three highly educational and complex cases that underscore the necessity of whole-body thinking, precise assessment, and pattern recognition in musculoskeletal care. Each case serves as a reminder that what appears straightforward at first glance often conceals deeper, more nuanced origins—and that effective clinical intervention hinges on both curiosity and clarity.
We begin with a compelling case of pseudo plantar fasciitis—a condition that mimicked classic plantar fascia pain but ultimately revealed a lumbar spine origin. The patient presented with medial heel pain, worse in the morning and during prolonged standing—textbook signs of plantar fasciitis. However, the absence of true fascial tenderness, coupled with a positive slump test and lumbar motion sensitivity, steered our clinical reasoning toward a lumbar referral. Treatment focused on lumbar mobilization and directional preference exercises, which led to rapid symptom resolution. This case illustrates the danger of anchoring bias and highlights the critical importance of ruling out referred pain patterns before jumping into local interventions. It's a textbook example of how regional interdependence and understanding neuroanatomy can save months of misguided treatment.
Next, we analyze a case of knee pain in a runner, a reminder that even seemingly simple cases require digging into the training narrative. The patient—a seasoned recreational runner—reported gradual onset medial knee pain after switching to a new training plan with increased downhill mileage and added tempo work. Clinical assessment revealed mild tenderness over the medial joint line and pes anserine, but what stood out most was altered deceleration mechanics and impaired eccentric strength on single-leg decline squats. The team unpacked how sudden changes in gradient, speed, and volume overloaded tissue systems that were previously undertrained, leading to a perfect storm for medial knee overload. The treatment approach combined tissue-specific loading, eccentric quad and adductor work, and a careful reintroduction of downhill running. This case is a great example of how training context—not just biomechanics—drives both injury and recovery.
Lastly, we dig into a chronic case of posterior tibialis tendinopathy in a recreational hiker and trail runner. This patient had been battling symptoms for over six months, with waxing and waning pain along the medial ankle and arch, particularly on uneven terrain. While imaging confirmed mild tendinopathy, it was the movement assessment that revealed key contributors: excessive rearfoot eversion, poor control of single-leg stance, and significant weakness of the tibialis posterior and proximal hip stabilizers. The clinicians also explored upstream drivers—specifically, reduced stiffness and motor control through the thoracolumbar junction and contralateral hip, which influenced lower limb loading. By combining isolated posterior tibialis loading, midfoot mobility work, and integrated gait retraining, the patient progressed back to full function without orthotics.
These cases highlight The FARM’s integrated, movement-first approach to diagnosis and treatment. Whether dealing with misdiagnosed nerve pain, training-induced overload, or chronic tendinopathy, the underlying theme remains the same: assess globally, treat locally, and always consider the full story.
