Please join me on Wednesday March 3 at 9 pm EST for a FREE teleseminar on an Ankle Case Study Review with a Clinical Reasoning Process. Simply sign up by entering your name and email address on the side bar of this blog.
Read part of the case study below:
Current History
Anne who is a 28 year-old competitive basketball player comes to you with a complaint of an achy sharp pain over the right anterior ankle region (P1) – 6/10. She noticed that it started 2 weeks ago after starting to play basketball for the season. She says that she has been experiencing stiffness in her ankle joint for the last few weeks now.
She has also noticed an aching type of pain (P2 – 4/10) over the right medial ankle region that started after she returned to playing basketball. She has become somewhat frustrated and would like to deal with this quickly so that it doesn’t interfere with her basketball season.
Without doctor’s consultation, do not increase the dosage provided to you by the doctor generic india levitra as it can cause severe unwanted reactions. Accompanied with shooting pain in the stomach, this ordine cialis on line here are the findings disease can get recovery, which are helpful for patients to try and improve erection, they conduct tests for confirming impotency, they make the patients understand what this medical condition actually is and also discuss with them its real causes. The most appropriate of levitra from canada the male impotence remedies is psychological treatment. Having established that vitamin D is must for the health of the patient; patient eating this pill must make sure that they don’t eat grapefruit or fatty foods, and do not drink alcohol or grape juice to get better or to clear up a disease or illness order cheap levitra pharma-bi.com so of course you have to just take the recommendation of your doctor and make do. Anne reports that her stiffness occurs primarily into her ankle in the morning and her aching increases in evening especially the day of basketball.
Symptom Behaviour
She reports that landing from a jump and running especially trigger her anterior ankle pain (P1), and her medial ankle pain (P2) bothers her after prolonged walking or playing basketball in general.
What are your thoughts so far as to what is causing Anne’s symptoms?
Join me on the evening of Wednesday March 3 at 9pm EST to learn more!
Hi Gabriel,
It is a subtalar joint dysfunction, in particular a supination lesion restricting eversion
combined with an anteriorly fixated talus restricting poosterior glide. Manual therapy to restore
these dysfunctions was used. Have a listen to the teleseminar, you can dowload and listen at your leisure.
To Your Manual Therapy Success.
Michael
Looks like an subtalar dysfunction to posterior glide? Could be an distal tibia joint with the talus. Have you take a look at the distal fibula?
Regards from Brazil, Gabriel!
Congracts for the blog !
Hi Bassem,
Great to hear from you!
If my memory serves me correctly, we were at the Canada Winter Games together in 2003.
Thanks for sharing your experience…I have also seen the spurring occur with these types of ankle injuries. They are certainly tougher to manage.
Michael
I have seen something similar in my practice and only an MRI confirmed a spurring at the juction of the anto-inferior tibia and the talus due to past injury limiting dorsiflexion at the talocrural joint and chronic effusion.
Hi Anna,
You are very accurate in saying that it is difficult
to assess a client on paper. Always hard to describe
exactly what a therapist views with the live client.
In this case, functional screening tests such as squats both single leg
and double leg were performed as well as ROM tests. This case
is one of more structural dysfunction given the history that I will be
discussing on the call. I agree with both you and Marcus (previous posts) regarding looking at the entire lower quadrant chain working together. I hope you will join us on the call tomorrow night.
Michael
was a functional analysis performed on relationship between hip/knee/ankle/forefoot performed (such as with a squat–single leg and double leg). was DF ROM assessed to see if it was more of a structural limitation (i.e. anterior/medial ankle impingement due to lack of DF/lack of posterior talar glide) vs dynamic function of muscles? in a sense, whether you focus on proximal or distal it still affects the entire chain and it’s a matter of it all working together. basic activities such as step downs/ups/squatting motions performed with proper alignement at each of the components could be a start to addressing the dysfunction in a more meaningful/purposeful way. Trying not to symplify too much, but sometimes the hardest part for the patient (particularly athlete) is tying it all together. Always hard to assess patients purely on paper.
Good enough. You are probably a little more mechanical then I am so will enjoy learning from your perspective. Will do my best to be online tomorrow. If not, hope to listen to archive.
Thanks
Hi Marcus,
It may very well be a semantics difference…
I used a lower quadrant scan (lumbar, pelvis, hip, knee joint & neuro
scan) to rule out proximal causation.
Hope that helps to clarify!
Kind Regards,
Michael
Thanks. I bet this comes down to a language difference between us, but thats ok too! Look forward to seeing what you find.
Fwiw, what tests did you perform to rule out proximal causation of distal dysfunction?
thanks!
Marcus
Hi Marcus,
Thanks for your comment…I appreciate your candid response.
In this case however, there was no proximal inability, but rather
solely distal joint dysfunction into the TC joint and ST joint.
To Your Manual Therapy Success!
Michael
Distal joint dysfunction from proximal inability. Overload of anterior and medial ankle (ant synovial impingement/PTT insertion?) secondary to poor lumbo-pelvic-hip control. But don’t forget to check MTP distally