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Happy Feet are Dancing Feet, Response to OMT in a Patient with Morphea Profunda: A Case Report

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 10-11. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/10/493538/LBORC-NUFA-Poster-Abstracts-2023-Residents)

Keywords:

ankle [33]
case report [514]
dermatoloy [1]
female [379]
geriatrics [48]
immune system [40]
localized scleroderma [1]
morphea profunda [1]
OMT [2951]
osteopathic manipulative treatment [2973]
women [333]

Abstract:

Introduction/Background: Morphea or localized scleroderma is an autoimmune condition characterized by sclerotic skin changes. Morphea profunda involves deeper structures including subcutaneous tissues, muscles, or bones. It is associated with significant morbidity from atrophy and decreased range of motion (ROM). Depending on the severity, treatment includes a combination of observation, steroids, phototherapy, physical therapy, or immunosuppressants. Currently, no published cases show benefits of Osteopathic Manipulative Treatment (OMT) in morphea profunda, though OMT can improve other restrictive diseases, such as Stiff Person Syndrome. Case: HG, a 74-year-old female, with recently diagnosed morphea profunda, presented to St. Barnabas Hospital’s OMT clinic with 2-year history of burning, bilateral ankle pain, associated with skin tightening, itchiness, loss of sensation, loss of ROM, and instability. The patient required a cane and caregivers for ambulation. Physical exam demonstrated decreased sensation and ROM of both ankles with 1+ Achilles reflexes and large, hyperpigmented, macular patches on bilateral lower extremities, and forearms. Osteopathic Structural Exam (OSE) showed moderate and severe somatic dysfunctions in cranium and lower extremities. Results: After 9 appointments over 7 months, HG showed significant improvement in ROM, mobility, and pain. Following the 6th visit, she reported unassisted walking along the beach and dancing all night in heels, for the first time since symptoms began. Discussion: Treatment focused on reducing postural decompensation and improving biomechanical and respiratory-circulatory function by improving ROM, promoting lymphatic drainage, and decreasing inflammation. HG demonstrated significant improvement of symptoms, OSE, range of motion, and activities of daily living after initiation of OMT, in conjunction with standard medical management. This case is limited by a sample size of one, so further research on use of OMT in Morphea profunda is indicated.


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