Ankle Joint Pain Casefile

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.

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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.

Ankle Fracture

This CT was taken 5 years after the injury. I don't think I have to highlight the talus fracture. Ankle fracture can be horrific if poorly managed.

Ankle anatomy

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?

Fig 2.

Ankle Joint Pain Casefile

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?

Chiropractic Help

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.

Fish oil health benefits

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.


Low back pain radiating to the front of the leg in an 83 year old woman... DEGENERATIVE LUMBAR DISC DISEASE 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

CLS writes:

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.

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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.

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