Therapy or surgery?

by CS

Diagram of ankle anatomy

Diagram of ankle anatomy

I am a 48 year old female. I have had fallen arches since my teen years. For at least the past 15 years I often get a sharp pain deep inside my left ankle; there is no pattern as to when the pain occurs. The top of my feet (over the arch) also hurts at times. I sometimes get blisters beneath my toes of the left foot. This past year I have noticed that my gait is changing. I had surgery on this foot in 1998 for a painful bunion, at which time the surgeon also shortened one of my toes by removing a piece of bone.

The last podiatrist I have seen wants to perform surgery to alleviate my pain and correct some problems. He said the tendons on the inner part of my legs/feet have given out. He wants to rotate my heel to provide more arch support then at a later time deal with the foot deformities.

Bad feet run in my family. I am on my feet most of the time when I work, so I have been unable to work as often as I would like. Do you think I should try chiropractic therapy first? I think my insurance only covers 15 chiropractic appointments per year. Does the surgery seem sound? I would appreciate your input.

Hello CS,
You are asking someone with a vested interest; I'm afraid I can't promise a totally unbiased reply.

That's major surgery that's being suggested, and always no matter what the problem, a more conservative course of treatment makes sense. You've little to lose from going for the chiropractic treatment; it's most unlikely to make the condition
worse and you might just get considerable relief.

I think it's important to decide up front what you would be satisfied with. With surgery or for chiropractic, for that matter. What I can tell you is that neither are likely to achieve a 100 percent cure. Would you be happy with 60% less pain?

Under the toes it sounds like you are experiencing a condition called metatarsalgia; it almost always responds well to chiropractic.

The sharp pain within the ankle joint is more complicated; it may just be a chronic subluxation in the ankle mortice or subtalar joints, both of which cause sharp stabs of pain. That responds well to chiropractic adjustments.

But you may have advanced arthritis in one or more of those joints; then it's a good deal more complicated and you may only get say 50 percent relief. Can surgery do better than that? I don't know, you'll have to ask the surgeon.

Look for a chiropractor with a FICS qualification; sports chiropractic. Your local chiropractic association may be able to guide you.

All in all a qualified yes, see a chiropractor who works daily with feet. Don't get sucked into expensive orthotics initially; and accept that 50 percent less pain is perhaps all you can expect with a long history like that. You would be able to continue with your work, whereas after major foot surgery you are looking at a layoff of several months most likely. The surgeon will tell you.

Spend some time talking to friends and family; not all chiropractors work with feet, and finding the right person is important.

Start our foot and ankle exercises which you'll find using the search function at Chiropractic Help.

I hope this contributes; let us know how you get on.

Dr Barrie Lewis

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Untreated sprained leg

by Sushil
(Bhilai, Chhatisgarh, India)

Sparined leg untreated after 21 days

Sparined leg untreated after 21 days

I have got a sprain in my ankle 21 days ago; at that time a lot of swelling was there but after treating by some home remedies on my ankle swelling was gone but I feel pain when I walk, and can't twist my ankle fully up and fully down; what should I do.

Hello Sushil,
With the common inversion sprain of the ankle, with or without tearing of the ligaments as you probably have had, looking at the photo, often there is simultaneously a subluxation of the talus bone. Walking remains painful.

A fracture is always possible too, in which case what I'm about to say will aggravate it. What's really needed is a proper examination.

But since you are unlikely to find a chiropractor in your neck of the woods, try this.

Lie on your back with your leg out straight. Ask a friend to cup the heel with one hand, and your foot with the other, and then distract the ankle by pulling down the long axis of the leg; it might help.

Dr Barrie Lewis

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Nerve pain

by Linda

I have pain that radiates from my right lumbar spine down to my foot but it also radiates up the back to the mid thoracic spine. MRI results shows spinal stenosis due to short pedicles in the lumbar spine.

I have been told by my PT that I have a anterior/posterior pelvic tilt.

I also have a varus ankle and am experiencing a lot of foot pain. I cannot walk for more than 4 minutes without pain and tend to shift my weight to the left side. When walking, it feels like my left side of the pelvis is pulling my right side to the midline when walking.

It feels like my right side is twisted and being pulled to the left.

Hello Linda,
This is complex but I can say with some confidence that neither your lower back or pelvis will settle if you are constantly limping because of a foot condition.

My own particular preference is to find the subluxations in the foot, give exercises, rather than orthotics which are notoriously difficult to prescribe, often setting up other problems if they are not exactly correct.

A short leg may be a factor too.

You've had those short pedicles since childhood; they aren't new. Do you have a family history of severe lower back pain? They certainly do complicate things, but predate all your problems.

An abnormal, limping, gait will certain affect the pelvis too.

If the Slump test for sciatica is positive then certainly your lower back needs to be addressed. How that is done depends on your philosophy and who you are consulting. A surgeon has a scalpel in his hand, a chiropractor only his hands, and a doctor medication.

If you aren't getting anywhere with one PT, try another, or a chiropractor.

Are you doing any back and ankle exercises every single day? That's where I recommend you start. See what you can do to help yourself.

Dr Barrie Lewis

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Achilles pain and inflammation after sprain

Diagram of ankle anatomy

Diagram of ankle anatomy

About a month after spraining my ankle I have resumed walking at work, which includes miles of multi terrain walking. My ankle does not seem to be hurting any longer but I have developed an irritating pain in my Achilles about 3 days after resuming work.

I did not perform physical therapy or get an MRI but the X-ray marked me clear of major fractures. Could this be a related issue to the ankle or an independently developed injury due to the weakening of my tendons?

Hello Nicholaus,
It's certainly related to your ankle injury.

If you read our ankle sprain page, use the search function to find it, you'll find that very often one or more bones in the ankle are subluxated when you twist it; in fact it's the cause of the sharp pain often felt.

That has changed your gait, and so of course other tissues are now complaining. Ignore it and you'll start getting knee or hip pain.

The posterior tibialis tendon is often injured incidentally and lies very close to the achilles. These structures need to be stretched and exercised; you'll find tips at Chiropractic Help on how to do that. But reducing any subluxated bones in the ankle is most important; it's not usually difficult provided you don't leave to too long. Look for a chiropractor with a FICS qualification; post graduate sports rating.

Let me know how you get on.

Dr Barrie Lewis

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How to treat pervasive pain from various untreated injuries over time

by Jon
(Long Island, NY)

X-ray of joints in the ankle

X-ray of joints in the ankle

I feel like more and more of my joints are losing function and need to figure out a comprehensive course of treatment but at this point I don't know what to do first, after better diet and exercise:

I am a 44 yo male. Here's a brief chronology of what I think are relevant causes:

When I was 10 or 12 I sprained my right ankle pretty badly, no fracture, and have been susceptible to sprains and falls ever since; more so after 18 years old and then periodically since then; it's not uncommon for it to give out and I fall if my foot hits uneven ground; maybe a few times a year these days. It affected both ankles when I was younger but mainly the right now.

The outside part of my right ankle (the bulging bone) bulges much more than normal and much more than the left.

At about 13 years old, I was "knee knocked" by an adult while playing basketball so hard that I felt it in my stomach and it knocked the wind out of me. His knee hit my right knee and I had to sit down to catch my breath and I kind of 'walked it off' but it was never treated.

At about 18 I had two jarring injuries that went untreated - one I went to do a flip 'over' a gymnastic horse only to land on it square on my lower back, perpendicular to it, I guess hyper extending my whole spine.

Not long before or after that, I got my head caught between a heavy swinging metal carnival ride car and the steel bar that was supporting it, kind of hitting on the right side and "crushing" my head and neck to the left - I saw a flash or 'stars' - I sought treatment for the 'tear' in my skin on my head; it only took four stitches, but I was never treated for the trauma or likely neck damage.

Fast forward 10 years, (with no intervening major injuries) I had weakness in my right arm and leg - to the point that I was dragging my right leg as I walked and I went to an orthopedist who ordered an immediate mri and surgery that night - herniated disks and spinal cord protrusion - I had one disc removed and a plate put in; that was in 1999 or so.

I always have stiffness in many joints; I don't get enough or proper exercise, my right side has been weaker since that surgery.

Then after a long drive I developed a pain in my lower back/buttocks area; I was treated by a chiropractor who wanted to treat my whole spine, and on my second visit he twisted my neck in a way where i saw stars again and a few months later after increasing to excruciating pain (and decreasing nerve function in my left extremities this time ) later i was diagnosed with additional herniation in the neck and disc matter migrating in the canal. So I had my second discectomy, they removed the hardware from the first and now I have a 'double' bracket.

Then a year or two ago walking down the steps I slipped with my socks on the carpet, and landed on my lower spine / hip more to the left side... at first it felt like it actually 'loosened' up some of my other tightness in my lower back, but I let it heal on its own and since that and the prior surgery my left side never regained full nerve function; tingling in the edge of the palm of my hand and pinky on that side, tightness in the elbow shoulder.

Since now my knees both - but more so the right don't let me get up after squatting down, total weakness and they were painful to lean on a few months ago but not so much now.

Lower back pain and stiffness is getting worse, and - that's where I'm at now. Like the tin man without oil. I'm pretty sure I need a lot of things like pins in my ankle to chiropractic or reflexology - but again I don't even know where would be best to start in order to get a comprehensive treatment, not just a band aid.

Hello Jon,
Thank you for a very explicit history; keep it somewhere, perhaps print it out for future use when consulting a new doctor.

Firstly accept there are going to be no miracles wherever you go, and whatever you do. Each of these problems is difficult in itself.

Secondly, don't expect any doctor to address all of them immediately; his or her energy is so diluted. They need to focus on one of these areas at a time; then when it's improving nicely, it's time to start the next.

I'd do two things. Firstly start an exercise programme for each of these areas and spend ten minutes a day working your ankles, your quads, the lower back and neck. Take your time; you aren't going to be selected for the next Olympics! So don't rush it; careful not to overstrain. There are exercises at Chiropractic Help for of them. Be disciplined and do them daily like you brush your teeth.

Then secondly start looking for a doctor, perhaps a chiropractor if you feel inclined to risk it! after your bad previous experience who specialises in feet and ankles. Someone with a FICS qualification; that's sports chiropractic. Improving your gait can only help everything higher up.

Incidently, remember it's YOUR body. Never allow any doctor of any ilk to bully you into having a procedure that you aren't comfortable with. Manipulating your neck like that was plain dumb and I bet he never even saw the xrays first. It's easy to say with hindsight, but you should not have allowed him to do it. Do your homework carefully and thoroughly before chosing another chiropractor.

That's just the start. I hope these thoughts contribute. Incidently I have doubts about very expensive orthotics for the shoes. Certainly they help sometimes.

Let us know in a couple months how you get on.

Dr Barrie Lewis

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Multi Problems

by Rick

1st part of my story; in 1974 while in the military boot camp I got shin splints and had feet problems. Then on 1974 the main tank gun knocked me off the tank and put me in the naval hospital for 2 weeks as I had severe Epididymitis.

Then shortly after I had severe feet and ankle problems, Neck pain and a lot mid and of lower back problems for 40yrs.

Now I am told i have prolifererative bony changes scattered the length of my spine and mild disc spacing at L5 - S1 with endplate sclerosis and subchondral sclersis of the facet joints L4-5.

My question is what did the hard fall onto a cement tank pad do to me? as the fall was bad and i landed on my feet very hard. I have had constant knee and bilateral feet pain and severe back pain for years and no one ever asked about my medical history and even now no one has figured out what's wrong with me until i asked for a new foot doctor and he said falls do something to the back and create feet problems.

They just did Xrays and found the above, I am scheduled for an MRI, But again what happen to me? when i was knocked off the tank and in the naval hospital for Epididymitis and no one ever checked for other injuries.

Any help or explanation to what happen to my spine, feet, knee from that injury would help me understand what happen to me as I am a disabled veteran who has suffered many years! Thanks Rick.

Hello Rick,
I think you've already told me the answer. That fall obviously injured a great deal more than the crown jewels. Your feet, hip, spine... but other things have almost certainly happened along the way too. A couple car accidents thrown in... so to pinpoint at this stage what the effect of that initial injury is, is impossible to assess.

In any case, is it actually important? Most of us have a long history of this and that. What's important it to get it treated, and get better. You won't be cured, not with pills, surgery or chiropractic. You have a chronic condition, like diabetes for example that needs treatment and maintenance.

I would be very surprised, not having examined you, or seen the xrays remember, if you weren't say 50 percent better at least after a course of chiropractic treatment. Would you be satisfied with having to live with half the pain of the last few years?

Start looking for a thorough experienced chiropractor who is prepared to struggle through this with you; chronic pain patients are hard on the doctor too, and some aren't willing to go the extra mile with you.

Don't expect miracles, and ask for exercises if none are forthcoming; you may just be very pleasantly surprised. Take your xrays and scans with you.

Not all chiropractors work with feet, so ask first. Don't just settle for a very expensive pair of orthotics for your shoes. Someone who will work at, and adjust your feet.

I'm sure there's someone around your corner able to help.

Dr Barrie Lewis

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Leg pain from knee to ankle

by Clay

X-ray of joints in the ankle

X-ray of joints in the ankle

I've sprained my ankle 3 times; the first time I was 16 skate boarding, the next time I jumped out of a 7 ton in Iraq and landed on a rock spraining my ankle. I went to medical; they said to take motrin and drink water the next day. I stepped on a small rock wrong and my ankle twisted and it hurt so bad I hit the ground and my rifle hit me in the head I went back to medical they took x-rays and said it wasn't broken they gave me crutches to use; I woke up the next day and my ankle was extremely swollen and I had black and green and purple bruising from the bottom of my foot to my knee.

After about 2 months I was able to walk again; a couple years later it started hurting when I would try to sleep; moving around during the day it was fine. I take pain pills to sleep most of the time. I was just wondering if there is something serious wrong.

Hello Clay,
Of course there's something seriously wrong; not cancer, just bad enough to make you take pills daily. That in my book is serious. All medication taken for a long period has side effects, often nasty.

When you sprain your ankle, four things relatively commonly occur.
1. Tear ligaments.
2. Pull muscles.
3. Subluxate bones in the ankle, usually the mortise or subtalar joints.
4. Fracture something.

If you leave it, it simply becomes arthritic and increasingly difficult.

Time to see either a chiropractor who specialises in sports injuries; look for a DC with a FICS qualification. Or, an orthopaedic doctor; your choice.

Dr Barrie Lewis

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