This ankle joint pain casefile serves as a reminder that the handrail on a staircase is there for a very good reason. Not one day goes by in a Dutch chiropractic clinic when one isn't faced with a acute or chronic injury.
When she was 25 years old, M was playing ring a ring a roses on the staircase when, guess what? All fall down, and a permanent rearrangement of her ankle anatomy. She fell down 9 stairs. Her foot was forcibly jammed into plantar flexion.
For 11 years she has been unable to place her heel on the ground. She walks on her toes, on her right foot.
Two bones were fractured, the medial malleolus, and the talus bone. The surgeon did his best with pins and plates, but the result has never been satisfactory.
She first consulted me for headaches and low back pain, coming of course from her strange gait. Could Chiropractic also help her foot. She didn't even ask. You must accept that you have to live with your foot, my dear, was the best her doctor had to offer.
The last operation three years ago, made the condition far worse, as the surgeon tried to trim away the arthritis that was forming within the joints.
The ends of bones are lined with a very hard, smoother than ice, literally, white substance called hyaline cartilage. This cartilage has no blood vessels of its own, and is totally dependent on fresh fluids within the joint for oxygen and nutrition, especially a substance called hyaluronic acid.
Fixate a joint for whatever reason for any length of time, and the hyaline cartilage begins to degenerate in a process now called immobilisation arthritis by scientists.
Fig 1. (CT scan)
Compare the dome of the talus above with the lovely smooth dome of the talus below. Chalk and cheese, no wonder M can't walk on this foot. Can Chiropractic help in this ANKLE JOINT PAIN CASEFILE? Ankle fracture ...a case for a chiropractor?
This next X-ray (Fig 3) was taken 4 years later (when she was 34). Notice how the immobilisation arthritis has progressed in the ankle mortise joint. The ankle anatomy is becoming severely comprised.
Fig 3. (Xray)
Note how on a CT everything is clearer than ordinary Xrays in this ANKLE JOINT PAIN CASEFILE. MRI is better still because the radiologist can then also assess the soft tissues.
Fig 4. (CT)
As you can see all three joints around the talus are a mess. Can Chiropractic help?
Sorry to give you such a bout of ankle anatomy but this ankle joint pain CaseFile is so interesting. Just you read on, if you are suffering from an ankle fracture, or even have not had adequate ankle sprain treatment.
Fig 5. (CT)
Carefully compare the cuboid ankle bones on the right and the left. Can you see how the cuboid has subluxated in her right foot? Note also the sclerosis forming there too - that's the beginning of immobilisation arthritis forming in the calcaneo-cuboid joint, and this CT was taken when she was only 30 years old. Can Chiropractic help ankle joint pain?
Neither M nor I can believe the improvement in her ankle. And it's not rocket science - I have simply applied basic Chiropractic help, not that different to any ankle sprain treatment. Active release therapy to the muscles in the calf, mobilisation of that ugly ankle mortise joint and reduction of the cuboid subluxation.
After only one treatment she could walk with her heel on the ground, and yesterday she reported that she went for a short shopping spree, walking far more easily than she has been able to for eleven years.
Let me hasten to say this will never be a normal ankle. She has had a severe injury of her ankle bones, but I'm convinced that if ankle exercises and mobilisation of this ankle fracture was started once the bones had healed - just basic Chiropractic help as applied to the ankle anatomy - much of this could have been prevented.
Update: We are now three months down the road in this Ankle Joint pain casefile. She consulted me originally for low back pain, stemming from her bizarre gait and headaches. Neither are 'cured' but she has almost no low back pain since she's walking so much better, and only very occasional headaches. She can walk for two hours with her heel flat on the ground, and minimal pain. I'm afraid she's a life-long patient.
I have every ankle joint pain casefile on a chicken bones bouillon and fish oil health benefits. Unless the basic ingredients in that hyaline fluid - a rich soup of glucosamine, chondroitin sulphate, omega 3 fatty acids, hyaluronic acid, oxygen and few hundred other vital chemicals - the restoration of her hyaline cartilage will be limited.
Fortunately she quit smoking two years ago. That alone reduces the oxygen in the blood by 20 percent and undoubtedly contributed to the poor healing originally of her injury.
Please note that case files have no scientific basis. There is little specific training for us in this field until the arrival of FICS, no research, and I'm working at the cutting edge, applying basic chiropractic help with 30+ years of experience, and a deep interest and passion for my work with this type of ankle joint pain.
It's really basic ankle sprain treatment, and quite soon we'll be starting in the rehab phase; plenty of exercises. Whilst the functional improvement has been little short of miraculous, in the short term, none of us know what the future holds. But we are optimistic.
I'll try to get another CT in a year's time, and see what progress we have made to the basic ankle anatomy. Perhaps just as important she is taking less than half the pain medication she was taking, mostly actually for the headaches coming from an atlanto occipital joint subluxation.
Analgesis and anti inflammatory drugs didn't help with her ankle joint pain. In short, if you've had a severe injury, been told there is nothing further that can be done, don't despair. But don't expect your chiropractor to do the impossible either.
Here is a case of similarly hopeless lower back arthritis.
A DEGENERATIVE LUMBAR DISC DISEASE CASE FILE ...
Low back pain radiating to the front of the leg in an 83 year old woman... DEGENERATIVE LUMBAR DISC DISEASE Case File ...