Hi all,
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Having some difficulty with a patient at the moment. He came in experience pain around the anterior margin of the ankle joint. He says it's OK after he's "warmed up" a bit, but then starts to cane when he cools down so to speak. He used to work in a warehouse, where at the end of a long day on his feet, he could "barely stand up". Interesting case, as he also has a Hx of clubfoot... Info:
- 25yo
- Ankle DF is -5 degrees on the left (doesn't even reach neutral, and o degrees on the right in NWBing. In a lunge to the wall test, his right foot is right up against the wall ie no distance recordable.
- His MPJ only has 30 degrees ROM on (L) side, and 40 degrees ROM on the (R). He has very low 1st ray stiffness, so he has a great deal of FnHL (I'm able to get greater ROM when I manually PF the 1st ray, but it is still greatly restricted
- Past Hx of a right achilles rupture (his achilles are basically a tight band)
- He is also tight through his hamstring and his back
- I sent him for x rays, which found some anterior impingement from dorsal talar beaking and tibial beaking on the right side, but they found NOTHING pathological on the left (he experiences pain on both sides.
- So I think this patient has some degree of anterior ankle impingement, but some of the pathology may also be coming from his gross sagittal plane blockade...
- My management so far has largely been set around trying to restore his ROM in AJ and 1st MPJ through mobilisation and stretching. I'm also trying to reduce the impingement through a heel lift and some KT tape to reduce dorsiflexion moments somewhat
- Pain has improved so far, but he's been on holidays. Returns to work this week, which will be interesting to see how he goes....
Does anyone have any ideas of what can be done here? His huge degree of equinus is worrying to me, and I wonder if a surgical option would be advised (perhaps an achilles tenotomy and possible clearing of osteophytic debris from the impingement). He is only 25yo so would rather not have an ankle fusion if it can be avoidable
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