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Guys,
I had a female 20 years old present to me with a history of ankle(Mainly Lateral) and dorsum of the foot swelling, intermittent in nature. Flat shoes can precipitate the swelling after about 1 hour of activity.
Medical History Unremarkable.
The inciting cause of the the swelling was a traumatic inversion sprain 7 years ago. Treatment at the time was a compression bandage.
An MRI of the ankle a few months later was unremarkable, as reported by the patient.
The patient had previously been supplied with Orthoses which I modified at a previous appointment. The patient reported the modified Orthoses have helped a little to reduce frequency of the swelling.
My question is are we missing something here, should more diagnostic imaging be sought?
Should the ankle be given a full rehab program? I have a vague recollection that the joint capsule can be torn in these cases and therefore they need surgical repair?
Any thoughts or advice would be appreciated, the patient is not in any great pain with the ankle, but it is a concern to her when the ankle swells.

 

Hi David

Based on your patient history, the problem could be caused by a subluxed cuboid secondary to the ankle injury that occurred several years ago. I use to have trouble treating these types of cases before I added osteopathic manipulations to my treatment protocols. This type of case is a good indication for the use of manipulations. I recall a number of threads concerning the indications for the use of manipulations. The osteopathic and chiropractic literature discusses the use of foot manipulations for acute ankle injuries. I have many successes using foot manipulations for vague lateral foot pain and swelling not caused by a fracture or inflammatory arthritis.
I hope this helps
Pete

Peter Guy BSc DCh
www.painfreefeet.ca
Whitby Family Footcare Clinic
107-420 Green St
Whitby, ON
L1N 8R1
905 668 8233

Peterborough Family Fotcare and Orthotics
329 Rubidge St
Peterborough, ON
K9H 4C8
705 740 8247

Professor
Chiropody Faculty
Michener Institute
222 St Patrick St
Toronto, ON
416 596 3101

 

Hi Peter,

Thanks for the reply, I hadnt even considered manipulation as treatment. I do notice you say its indicated for acute ankle sprains. Also this patient has no pain, only from shoes when the swelling occurs. I really do need to get to the cause of the swelling to reduce the impact it has on her quality of life.

Cheers David

 

Hi David
I didn't want to include chronic ankle sprains because I was not sure of the references for chronic ankle sprains and manipulations. My clinical anecdotal evidence has demonstrated the reduction of swelling on the dorsum of the midfoot. The osteopathic manipulation method focuses on the reestablishment of lymphatic circulation which can be blocked by adhesions around the midfoot joints. I have been told by a number of patients that the swelling around their ankles reduced after the manipulations were performed. I do not ever guarantee that the swelling will be reduced but it does happen in a majority of the cases after a few manipulations.
Pete

 

"An MRI of the ankle a few months later was unremarkable, as reported by the patient."

I'm sure there is something on the MRI, there usually is......

I would suggest chronic ankle synovitis, with or without a Sinus Tarsi syndrome.
MRI readings (especially a foot/ankle) are quite variable in quality. You should read them yourself.

Steve