ankle injury

by kez

Foot immobilisation arthritis (see the sclerosis?)

Foot immobilisation arthritis (see the sclerosis?)

Ankle injury

Sprained ankle a year ago still swollen at ankle burning tingling .

mri 4months ago no bones broken,painful when walking across the top of foot does not seem to be getting any better?please help

have insole that have been made for my feet still painful when walking.

Hello Kez,
Yes, a distressing situation. Obviously something has been missed.

It's not likely the radiologist missed a fracture, but you could start by asking for another radiologist to read the scan. It happens.

Torn ligaments and tendons shouldn't be still swollen. Unlikely the main cause of your problem.

So we assume a joint injury, something not readily seen on the scan in the early stages. Later what will occur, if there is joint fixation, and there probably is, is that immobilisation arthritis … will set in, and then it becomes much more difficult to manage.

So you are quite correct in now seeking other opinions. Continue that search until you get answers, otherwise there's a good chance you'll have a disabled foot in 5-10 years time. In fact you are already partly disabled.

Hyaline cartilage is the vital substance lining joints and it's dependent on movement for nutrition. Immobilised > unerring to joint arthritis.

In the MRI above you can see how a subuxated cuboid bone in the foot is becoming arthritic along with the neighbouring heel bone. This scan was taken 10 years after an ankle injury.

What's needed is a good thorough clinical examination to locate the spoke in your wheel. It the pain is across the top of the foot I'd be checking the cuneiforms and navicular particularly but it could be any one of the many joints in the foot, as you can see from that scan. Only a very careful exam will find your problem.

Check out this ankle joint pain casefile for an injury much worse than yours, but the principles are the same.

Find a good chiropractor is your next stop. Look for someone with either a FICS sports chiropractic qualification, or least who works extensively with feet.

Good luck, let me know in a month how you get on.

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Dr B

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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.

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