Old Ankle Injury causing foot, knee and hip problems

by Robert Stringer
(Mount Pearl, Newfoundland, Canada)


My Name is Robert.

When I was in my late teens I severely sprained my ankle. I was playing casual tennis, leapt with both my feet and rotated to perform a backhand. My lead foot came down with toe first and then on to the back of foot in a twisting motion. I fell to the court unable to move and almost losing consciousness. There was a loud popping sound, it felt as if my leg was going into the ground.

Doctors were very surprised nothing was broken and there was not a major tear due to the trauma. My foot looked like balloon, my leg was swollen to my knee, completely purple, blue etc.

In the next three years following I severely sprained (not quite as bad) the same ankle three more times.

While I lost my ability to spring off that ankle with the force I used to as I was a very competitive badminton player I was still able to perform most tasks effortlessly. Cycling, running etc.

Sometime starting in my late thirties my ankle began to stiffen and become numb, especially after any activity. Then in my early forties my right knee/knee cap started to feel misaligned/unstable as if it wanted to rotate inward when stepping and felt out of place. I could feel the knee cap unlike my good left knee cap which is just there. Ability to spring was greatly reduced, pronation of my ankle became severe. I experience drop foot (inability to raise my foot toward my leg) partial lack of sensation in my foot and improper gait.

I am now forty seven and am experiencing all of this but twice have after pushing my self physically have experienced back/gluteus/hip pain which is fairly extreme. I've also noticed my right hamstring gets abnormally tight with activity. My leg literally feels like a mess from my big toe to my waist.

I am not sure how to attack this. Over the years I have seen family doctors, done physio therapy, worn three different sets of orthotics, talked to a sports medicine specialist. None of this has helped. I am "guessing" I have severe pronation due to my damaged ankle and probably an impacted nerve causing all of these issues.

How/who/what type of specialist do I need to see to get this evaluated and treated properly. I am Canadian and doctors are very reluctant to give MRI's etc. My experience has been to be referred for physio therapy or to get orthotics. I have done both and feel they are treating symptoms and not my actual problem. I have only gained temporary relief (if any) from treatment. In fact, I feel long term use of orthotics has actually helped to worsen the condition of my ankle.

Any insight and help would be greatly appreciated.

Hello Robert,
There certainly was a major tear, it just wasn't detected. With that amount of swelling, and what's known as eccymosis, you can be sure something tore. That changed the whole dynamics of your ankle, and hence the knock on effect up your leg. An MRI certainly would be indicated today, but was not readily available back then.

The specific concern now is that foot drop; the most common cause is a pinched L4 nerve root, but you don't make great mention of lower back pain. However that tightness in the back of your thigh spells sciatica to me, and hence the foot drop.

It's complicated because the L4 nerve root belongs to both the sciatic and femoral plexi, and can affect either nerve, or both. Have reflexes and skin sensation been tested? With a foot drop one almost always sees a loss of the knee jerk, or perhaps medial hamstring reflex.

You can test for a pinched nerve by doing the Slump test for sciatica. Use the search function at Chiropractic Help and you can do the test at home, with the help of a friend. Let me know the result. The femoral nerve stretch is more difficult.

There's an advanced sports specialty in chiropractic after following the FICS prgramme. I recommend you call your local association and ask if there's a local FICS graduate.

What's needed is a very thorough examination of your ankle, knee, hip, SIJ and lower back. There's certainly stuff lurking there, and it's the kind of stuff that a FICS graduate would love to delve into and treat.

Let me know how you get on. Start with the simple, basic lower back exercises that you'll find in the navigation bar on every page.

Good luck, I hope this contributes.

Dr B

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Jun 11, 2015
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Physiotherapist
by: Robert Stringer

Dr B,

Thank you very much for your input. I saw a psychotherapist recommended to me by a friend who is a very accomplished level athlete.

I was tested thoroughly. He believes that I likely have a pinched nerve in the L4 L5 region of my spine. He is writing a recommendation to my doctor to get me a CT scan. He is concerned about my inability to dorisflex my foot upward.

He is focusing on this and the pain I feel in my glute when doing the Slump Test for Sciatica. The pain I feel now is quite subdued to what I felt in the first four weeks after an injurious run. However the pain is still very real as is the feeling of a deep bruise in my glute as one might feel after slipping and falling hard on ice.

Once we get to the root of this my therapist then wants to attack the issues with over-pronation or as he put it excessive movement in the joint. The pronation does not appear that severe until I walk then it is very apparent that there is excessive play in my ankle causing instability and misalignment throughout the chain. He tested me and there is partial loss of sensation. I liken it to having my foot partially frozen all the time. There is also tell tail signs of stress from my heel/instep to the tip of my big toe.

He feels that with proper stretching, weight training, and other techniques that substantial improvement can be made. But first things first.

Hello Robert,
It's good that your physio and I agree! One suggestion, go for an MRI rather than a CT. The latter is massive ionising radiation and gives less information about the soft tissues.

Let me know when you have the results.

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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