Objective: Describe how lymphatic drainage (LD) resolved obligatory toe walking gait and stance in a boy with Autism Spectrum Disorder (ASD). The treatment plan was generalized from an identical treatment given to a collegiate athlete with chronic spasms of gastronemii.Design: Review of medical record; photography evidence.Intervention: A single treatment of LD. No literature suggests a fluid anatomy model for manual therapies as treatment options for toe walking. This case highlights an effective method discovered to quickly reverse functional deformities despite several years of traditional pediatric interventions for toe walking in ASD.Results: Full weight bearing contact of bilateral plantar surfaces was gained in stance immediately. Active-assisted range of motion and progressive resistance training began to progress only after this breakthrough. Gains have since been made in gait and stance normalization, and foot kinetics. More invasive interventions (serial casting; reconstructive surgery) have been avoided. Gains sustained as evidenced in one year follow up. Conclusion:Emerging paradigm of lymphatic and interstitial anatomy provides novel treatment to change the functional status of muscle tissue and tone. Changes in passive and active ankle range of motion were a direct result of mobilizing and evacuating fluids of the gastrocnemii via lymphatic pathways. Spontaneous muscle softening and Achilles tendon lengthening happened instantly. An extremely light touch and pressure input from the therapist is required to perform lymphatic drainage. Lymphatic drainage massage holds promise for further use and study with issues such as toe walking gait and other orthopedic populations.
Evaluating and treating soft tissue masses is a component of podiatric practice that few will be able to avoid. Indeed, of all soft tissue masses, ganglion cysts appear to be the most common. Many of these can be adequately treated with fine-needle aspiration. However, in other cases, surgical excision may be indicated, particularly when the cyst is pressing against a nerve or similarly sensitive structure. In this case report we seek to analyze one case of a painful soft tissue mass that was originally diagnosed as a ganglion cyst, had failed fine-needle aspiration, and was analyzed under MRI to be a case of "tenosynovitis." The goal is to understand that, all similarities aside, no two soft tissue masses are completely identical, and that it is important to obtain the correct diagnosis early in treatment, to render the appropriate care so that the symptoms do not become debilitating or impact the patient's activities of daily living.
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