nerve? pain proximal tibiofibular joint

by Els

Healthy, sportive, woman, 49, athletic, slim built.
I had a high tibial, closed wedge osteotomy (9 degrees) on my left knee six years ago. Since then I have progressive pain at the proximal tibiofibular joint radiating to the superior tibia at the front. Pain worsens when walking especially when walking longer then about 40 minutes, but also often even when I start walking.

One legged balance exercises cause symptoms.

Sitting in a plane or car for more then 45 minutes make me want to scream. Lying on the couch with straight legs and feet crossed cause severe symptoms. Just as lying in bed on my right side with bend knees. Lying on my left side isn't possible for more then a few minutes. The pain lessens when I stretch my legs but it takes quite a while before the pain goes.

The strength in my left lower leg is quite a bit less then in my right. Climbing stairs is difficult as is walking uphill. It feels like I have to drag my left leg along. It feels as if there is hardly any transfer of power.
When walking my left foot doesn't unroll completely. But you can't see it unless you pay very good attention.

I don't have ankle pain but the ankle moves like shit according to the physio and orthopedic surgeon. There is also pain radiating to the lateral side of my leg and along the tibia.
Sometimes my left lower leg feels like is it is ice cold. It feels as nerve pain.

Orthopedic surgeon doesn't understand it and doesn't take it seriously, phyio thinks it may be some kind of subluxation. Manual therapist said the fibula is displaced superior. He manipulated it several times. And that felt great. I felt life streaming back into my leg, it tingled and felt much better, lighter but within a few hours it went back into it's wrong position. EMG was good. What is this and what can I do? I am quite desperate. Thanks, Els.

Dag Els, maar ik zal in het engels schrijven.

I know the EMG is good, but I'd like to see testing of each of the muscles in the lower limb done. Some you could do yourself, but it's rather technical.

For example, can you raise your big toe, and can you raise your heel off the ground, standing on one leg. Does the knee give, and is there wasting of the quad, or other muscles?

Is climbing stairs difficult because of pain or weakness? In the knee or ankle? That lack of movement in the ankle is very real pointer; work out specifically which muscle is involved.

Could your manuele therapeut teach your husband how to reduce that subluxation of the fibula head? Perhaps if it was done regularly you might get some lasting benefit.

Ask someone to do Noble's test for an ITB.

Test the pulses in the ankle and foot with the knee straight and bent.

What was the reason for the osteotomy? An injury in gymnastics or something similar?

Time for an opinion from a different orthopaedic surgeon; your current guy hasn't a clue obviously and worse, sounds like he's in denial.

I fear you may be in for a total knee replacement, this is obviously very disabling.

You might look for a chiropractor with a FICS post graduate qualification; sports injuries. Contact the NCA and they will give you some names.

I fear I haven't contributed much, but perhaps a few pointers.

Doe het kikkerlandje de groetjes!

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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