ankle discomfort

[paulm]

Patient presented with plantar heel pain R, diagnosed p/f, back injury sometime ago (r/t/a) hence limited activities...patient retired female teacher, 72 yrs old....
prescribe leather balanced orthotics which reduced symptoms to zero......i had to modify orthotics after a time because she felt they were tipping her forward (not a footwear issue) i just reduced the heel thickness...this resolved this issue.....patient now reports cannot wear orthotics (9 month down line) is now wearing an elastic support.....she reports she gets a sensation that her ankle, location just distal to tib/fib/talus articulation, feels as if its about to lock and break..this happens with/without orthotics...feels elastic support better than orthoses now... ideas greatfully appreciated.....i will be seeing her in a couple of weeks

regards
Paul

[Admin]

Hi Paul,

My initial thoughts are that your orthoses improved the PF (therefore they worked) and at the same time probably improved foot function.

Increased activity (bound to be now the PF is gone) has resulted in aggravation of another injury or problem at the talo-crural joint (I think this is what you are describing?).

Did she injure this ankle in the RTA?

Have you tried manipulating the TC joint?

Cheers,

[paulm]

Have you tried manipulating the TC joint

no but i will

[TimVS]

I was thinking that.....honest!!

[robertisaacs]

Hello Paul.
It would be helpfull to know a bit more about the patient. Specifically:-

What was the cause of the PF?

What was the nature of the orthotics (leather balanced does'nt tell us very much!)

What was the nature of the gait before and after having the othotics?

Was there extensor substition present before the orthotics were fitted?

WHat is the QOM at the TC and at the STJ?

What is the saggital range on the ankle?

Is there an LLD?

Without knowing more details it is hard to extrapolate what the problem is.

Regards
Robert Isaacs

[Martin Harvey]

Back injury...... are the dermatomes normally sensate? any suggestion of pain tracking from the nerve roots? If spinal canal / inter-vertebral foramina stenosis is causing nerve root compression this could be a possible factor, just a thought, cheers, martin.