Physical Therapy for A 57 Year Old Male with Chronic Back and Bilateral Foot Pain Using Directional Preference and Gait Training: A Case Report

Purpose: The purpose of the case report is to describe the therapeutic approach of using directional preference and gait training on a patient with low back pain with radicular symptoms post bilateral bunionectomy with second toe reconstruction. Case Description: Patient was a 57 year old male that presented to physical therapy with chief complaint low back pain with radicular symptoms into his right hip and posterior thigh and bilateral foot pain. The patient reported a history of bilateral bunionectomy and second toe reconstruction in 2016 that was also treated for 4 weeks into his treatment time secondary to pain and decreased sensation during ambulation. The patient participated in 12 sessions of outpatient physical therapy for his low back pain with radicular symptoms and 9 visits of outpatient physical therapy for bilateral foot pain, consisting of directional preference exercises, manual therapy, cryotherapy, gait training, therapeutic exercise, neuromuscular re-education, therapeutic activity and patient education. Outcomes: The patient’s pain was assessed using the numeric pain scale at the initial evaluation and was 5/10 that would increase to 8/10. His pain decreased to 2/10 at his last physical therapy session for his low back pain. The patient reported centralization of lower extremity symptoms at discharge. Bilateral foot symptoms changed minimally but he was able to ambulate further before onset of symptoms compared to before treatment. The modified Oswestry disability index (ODI) initial score improved from 64% disability to 46% disability and the lower extremity functional scale (LEFS) score was unchanged at final session. Discussion: This case report suggests using directional preference, specific exercise and gait training may improve outcomes for a patient with low back pain with radicular symptoms and bilateral foot pain