Ankle Joint Pain case file

Ankle Joint Pain Case File covers a runner's acute injury.


A patient, Miss P, a highly competitive runner for the last 15 years, enjoyed a normal 10k run several weeks back, all without incident. But the following day she woke up enormous pain in her right lower limb.


She recalls having injured her foot quite badly several years previously, but it resolved without comment and without any treatment. Perhaps it left her with a subtalar fixation, but that is speculative; that what she had on presentation at the clinic. Look for it in the diagram below.

Walking on the inside part of foot, known as eversion, together with an exaggerated heel to toe posture on the inner side of her foot she said brought her relief. This would have prevented the normal pronation supination that you can read about below. It stopped her from rolling the subluxated subtalar joint in the usual normal manner.

Normal walking posture provoked the sharp stabs. That would involve pronation and supination. She said the ankle was very stiff in the morning and it woke her up during the night, but with no sign of swelling.

She described the pain as deep and boring. It felt like bone pain. She thought originally that it was a dancer's fracture; it was that intense. From overuse of the muscles on the side of the leg, the Peronei muscles, she thought must have been causing the ache in her lower limb.


Ankle Joint Pain case file


That Peroneus is in fact three separate muscles, and the tendons do indeed pass very close to the subtalar joint.


Examination of our ANKLE JOINT PAIN CASE FILE

The movement we call EVERSION of the ankle was severely reduced with moderate tenderness over the anterior part of the subtalar joint. Otherwise there were few findings. See the subtalar joint in the pic above? And where the arrows are in the X-ray below. That's where I found the spoke in her wheel.


PROGRESS in our ANKLE JOINT PAIN CASE FILE

She reported immediate relief of ankle joint pain after the first Chiropractic adjustment of the subtalar joint and within four treatments, in two weeks, she was completely over the pain and running normally again.

Impossible, a miraculous recovery with Chiropractic Help? Because she knew she had an injury, and didn't wait weeks, or months, or ... yes, we see people with this injury often years after it has happened. She presented herself two days after the injury.


Now, says she, when I do peroneal strengthening and stretching it feels lekker. Good, or nice. Ankle exercises are a vital part of ankle sprain treatment.




The SUBTALAR or TALO-CALCANEAL JOINT (actually jointS)

ANKLE JOINT PAIN CASE FILE

This is a synovial joint meaning that it is filled with a lubricating fluid full of juicy chemicals and oxygen that feed the stuff which lines the bones in most joints - what we call hyaline cartilage . It's at the heart of ankle sprain treatment. This cartilage is very hard, gives slightly on pressure, and is extra very super-slippery.

An aside: Try making our CHIROPRACTIC HELP mutton stew from neck of lamb. Delic, and easy. Whilst you're enjoying a finger-licking-good neck bone, run your finger over one of the joints. Super-slippery. That's what healthy hyaline cartilage looks and feels like. Allow that joint to subluxate, and remain fixated, and (within 13 hours the anatomists tell us) that hyaline cartilage, starved of nutrients begins to lose it's super-smoothness. It's called IMMOBILISATION ARTHRITIS.

(PS. Pay Colonel Saunders a visit this week. He had a rotten back, and was eventually saved by a Chiropractor. He was so impressed that he gave a $100 000 every semester to our Chiropractic College for needy students. I really owe him ...! Then save the chicken bones and make your own cartilage nutrient bouillon, a proven big help for stubborn arthritis. )


The CALCANEUS, or HEEL BONE

ANKLE JOINT PAIN CASE FILE

The CALCANEUS, is the largest bone in the foot, and it takes a pounding! When you walk and run it's your heel that you land on, and it takes the full weight of the body.

As you can see it's a highly complex bone ...


Fig. 4



ANKLE JOINT PAIN CASE FILE: Why do I do it?

Friends and colleagues, and "she who must be obeyed"!, sometimes ask why I "waste" so much time writing Chiropractic Help. A good question, and yes it does take a lot of time. Each of these pages takes at least 2-3 hours, this one much longer.

  1. I just enjoy it. Strange, but I find it fun and relaxing.
  2. I find patients have very little idea of what and why we Chiropractors do, and why the art and science of Chiropractic is so important. Chiropractic Help is a good teaching tool - I do it for you!
  3. Periodically I get fed up with my alter ego, Dr Bernard Preston. Yes, I lead a double life! Writing Bernard Preston's fanciful tales from the Chiropractic Coalface is very monotonous. Seriously, each chapter from my new book has been written, read, re-read, edited ... at least thirty times. It's SIX WHOLE YEARS since I started STONES IN MY CLOG, no exaggeration. It's tedious, so I escape Bernard Preston's clutches periodically, to rather enjoy your company at CHIROPRACTIC HELP! You're much nicer than that 'ole fart Preston! BERNARD PRESTON ...

Stones in my Clog - only $2.99 on your Kindle or smartphone.



Shall we be serious again? Chiropractic Help is also an important learning tool for me. Believe it or not, I've been treating the subtalar joints for years, and I had no idea there were three of them until now. Do you think that helps my understanding of ankle joint pain, and allows me to better help patients with ankle sprain treatment? Absolutely.

If the master found it important, then it's important for me too. And you, are you still learning?



"I'm still learning."

- Michaelangelo

(said when he was 85)



Back to our
ANKLE JOINT PAIN CASE FILE

ANKLE JOINT PAIN CASE FILE

What's interesting about the Posterior Talo-Calcaneal joint (remember: Subtalar = Talo-Calcaneal, just another name for the same joint) is that the Talus above, and the Calcaneus below have matching concave surfaces. Go back to Fig 2 and look at those little arrows. That makes the joint very stable and solid, and able to take the shock of the heel landing with the foot in dorsiflexion.

However, the Anterior Subtalar joint is convex-concave allowing the foot to roll onto the Medial Subtalar joint, what we call pronate-supinate when the foot is neutral and in plantar flexion.




PRONATION SUPINATION

ANKLE JOINT PAIN CASE FILE

Ankle bone anatomy is a fascinating subject. We are truly, as one surgeon wrote, fearfully and wonderfully made. He's absolutely right!

When you are walking or running, you land on your heel with the foot in dorsiflexion. The stable posterior subtalar joint takes the shock beautifully.

Then, the foot goes into slight plantar flexion (drops), allowing the weight to be taken over the the anterior and medial subtalar joints which are convexo-concave, and your foot can roll inwards, in what we call pronation. It's quite normal, and happens on every stride.

Then, mid-stride, the knee moves forwards over the toes, and the foot is again moving into more rigid and stable dorsiflexion for the toe-off phase of your stride. Now, as the foot plantar flexes during toe-off, the ankle rolls outwards, into what we call supination. This supination apparently, from an engineering perspective, gives the calf muscles more leverage as you push off. Beautiful, beautiful ankle anatomy.

Every step, roll in, roll out, pronation, supination.



To complete our ANKLE JOINT PAIN Case File here are a few more thoughts. 

During our young friend's jog, something went haywire in the anterior-medial subtalar joints. This joint stuff is all a bit mysterious, I must admit. We find it just as frequently with low back pain - you go to bed fine, you didn't have sex!, a normal night's sleep, and in the morning you roll out of bed and bingo. Ouch, +++ lower back pain.

My take is that a joint fixates from some, perhaps seemingly minor, injury during the day. You're not aware of it. You go to bed fine, but during the night, the normal refreshment of the joint fluids is inhibited by the fixation, it swells perhaps deep inside the joint, and you wake up in the morning with severe pain.

It's one of the reasons I stress exercising your quirky joints IN BED, last thing at night and before getting up in the morning. Two minutes, that's all it takes, will save you heaps of drama.

When you know you've done a mischief to your back (watched "The Two Ronnies"? - the very best of Brit humour) or your ankle, don't wait weeks before you consult your Chiropractor. And don't waste your time with anti inflammatory drugs and painkillers - get that subluxation reduced as quickly as you can. Ice, taping for your ankle sprain treatment and an ankle guard for a while may help too.


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» Ankle joint pain case file



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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.

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