Pain high up in ankle when heel pressed upwards

by Ruby
(Farnham, UK)

X-ray of the ankle

X-ray of the ankle




Hi there,

I fell down a short set of stairs 9 months ago and managed to recatch my balance but ended up catching my left heel very hard on a stair.
My chiropractor said that my pelvis was shifted out to the right and forwards by the impact (my back is realigned and ok now).

I have taken it very easy for 9 months - no high impact sports. However, I still have discomfort and pain when I do anything that pushes the left heel upwards (such as wearing a shoe with a heel, walking down a hill or down stairs).

It is hard to describe exactly where the pain is - it is almost above the ankle, at the back (above the bony bit of the heel) and it is very deep inside.

Also when doing a glut stretch and crossing the left ankle over the right knee so that there is pressure on the outside of the left leg just above the ankle, there is also discomfort.

Any thoughts what this is and any tips on what to do? I'm an active person and would love to get back to a normal exercise routine.

Many thanks!

Ruby (UK)





Hello Ruby,
Obviously something happened in your ankle, as well as in the pelvis. Has your chiropractor examined your foot? You have told him or her I presume.

Joining the foot to the lower leg are two joints; the ankle mortise and the subtalar joint. Actually the latter, is a complex of three joints; see our ankle joint pain page.

When subluxated it causes very sharp pain, just as you describe. Normally it responds very quickly to a couple of simple adjustments, unless the cartilage was damaged, or worse a fracture lurking there in the ankle.

Not all chiropractors treat feet; I'd discuss it with your DC and see if he can't refer you to a colleague who has a FICS qualification; chiropractic sports injuries.

Then some alphabet ankle exercises would help too; see our site using the search function.

If it doesn't respond, ask for a CT of the ankle; plain xray often misses a subtle fracture.

Good luck; let me know how you get on.

Dr Barrie Lewis



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Ankle injury left untreated

by Jennifer
(Pierson FL, United States)

A little over 3 years ago I received an ankle injury and went to the ER at a hospital; they took x rays and determined it wasn't broken. When I left they left me these papers saying I had to return to a rehab center or something around that so that my ankle would properly heal. I did not do this.

Since then my ankle has never properly healed and it has causes me to experience a lot of pain when standing or walking for too long and numbness when I run. It has also affected my knees and they now shift inward at the knee cap. I also got these knot type balls on the lower back (that i'm guess formed from extra stress on my bones due to the fact that i was no longer standing or walking properly). They are both the size of a golf ball and i have one on either side of my lower back. I was wondering what they could medically be? and if they proposed a danger to me now or in the future?





Hello Jennifer,
It's hard for me to speculate about the golfball size masses on your back; what's needed is a good examination of your lumbar spine and pelvis. Meantime start some lower back exercises that you'll find in the navigation bar at Chiropractic Help.

Time to find someone who knows about ankles too. I'm not going to lecture you; you know what lies ahead if you don't.

Dr Barrie Lewis



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Old Ankle Injury causing foot, knee and hip problems

by Robert Stringer
(Mount Pearl, Newfoundland, Canada)

Diagram of ankle anatomy

Diagram of ankle anatomy

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 Barrie Lewis




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Jun 11, 2015
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Physiotherapist
by: Robert Stringer

Dr Lewis,

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 Barrie Lewis





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Feels like being jabbed by needles in my ankle

by Gracie
(Kelowna, B.C, Canada)

I was walking around town for a bit when my right foot started to ache. I thought my foot was asleep and the drowsiness in my leg would go away. After about two hours the pain ached more and I could feel it more and more becoming more sharp in my ankle.

The pain went away for around three hours but now it's back and I am currently lying on my couch with a sharp pain mainly in my ankle but also in the soles of my feet. It is definitely not pins "n" needles. My friends have said that maybe it's my bones shifting but I am already 14 and have practically finished growing.
thank you,
Gracie





Hello Gracie,
My first thoughts were of a subluxated bone in the ankle. Does moving your ankle hurt?

However, talk of your foot falling asleep and a "drowsiness" suggests this could be something else. There are just so many possibilities, that I'd prefer not to speculate.

If it stays more than a few days, a visit to your medical doctor may be in order.

Dr Barrie Lewis



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Painful ankle

by Clarissa maaon
(UK)

I have a constant dull achy pain on the inside of my right ankle. Im also experiancing a sharp pain on the arch of my foot. I fell a few months ago my ankle swelled and bruised almost straight after the fall. I have trouble when applying any pressure to my ankle. I went to A & E but they didnt xray they sent me home with an ankle aupport.

I was wondering if there is more going on than I was told. Thanks.





Hello Clarissa,
One can't xray every case of trauma, unless there are definite indications that there is probably a fracture.

You should have been told to come back in say ten days for a reassessment.

What's needed now is a careful, thorough examination, and probably an xray and even a scan. Fractures are often missed on plain xrays.

Time to find someone who knows about feet; talk to friends and family and your medical doctor.

Dr Barrie Lewis



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