Restricted range of motion following ankle sprain

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I have just examined a patient who has restrictricted sub talar joint. His foot lies in a 5 degree eversion when in resting calcaneum stance. He is a runner and has not been able to excercise for a while as he gets discomfort at the area of the top of the STJ when running. He also has a functional hallux limitus. I have supplied arch support insoles with a kinetic wedge. I also want to apply a rearfoot medial posting to improve the STJ.
Have you come across the same sort of complaint followiing ankle sprains? (His ankle sprain was years ago.)Is there any advice you can give me on this? He has gained temporary relief from manipulation.
Thanks all.

 

Three thoughts:
Was there limited range of motion before the sprain?
Peroneal spasm / splinting
STJ coalition

The treatment would be different for differnt diagnoses.

Regards,

Eric

 

Where exactly is the discomfort? Sinus tarsi?

 

My gut feel is that ankle dorsi-flexion range regained will be proportional to the degree of recovery. Compare lunge with opposite side; then work your butt off to restore it.

BTW, equinus stretching will help only 40% of these lunge deficits; so you might have to dig deep into your therapeutic knapsack. Sounds like antero-lateral impingement to me.



Ron Bateman
Physiotherapist (Masters) & Podiatrist

 

A common subluxation pattern occurs with an inversion ankle sprain resulting in an antero-medial shift/displacement of the talus. This disrupts the congruence of the articular surfaces resulting in reduced RoM in the ankle.

As the injury occurred 'years ago', the connective tissue adaptations would most likely have resulted in maintaining the subluxed positions of the talus:ankle mortice and the talus:calcaneus.

WB x-ray (DP and Lat views) will give you the opportunity to assess if there is a talar subluxation by checking the cyma lines on both views. A 'break' will be evident with an anterior talar subluxation.

IF a subluxation is present, chances of a successful result will be improved when the subluxation is reduced or corrected.

But, as Ron says; work your butt off to restore it there will be some work required.

Ted.

 

Thanks for your replies. I have just had a review with this patient and it seems the insoles and medial posting have been successful. He is not experiencing any discomfort. He is going to attempt a run this weekend.
His ankle range of motion is normal, it is purely the sub talar joint that felt restricted. I did palpate the area around the lateral malleolus and he felt discomfort around the site of the calcaneofibular ligament.