CASE REPORT: 23 year old female who 2 years ago fell down the stairs and had an acute injury to her lateral ankle from a forced plantar flexion/inversion moment. She was running down a long staircase and her foot slipped off of the front edge of a step and she went down. Her initial pain was over the lateral side, typical of a lateral ankle sprain. -
Over the past 2 years she has had 2 MRIs (both showing mild soft tissue injuries to the lateral ankle) and has seen a primary care physician, orthopedic surgeon, podiatrist, chiropractor and physical therapist. The standard answer has been that her pain will just get better over time. Her physical therapy consisted of single leg balancing exercises and picking up marbles with her toes. She has received a rating of a 25% disability on her leg going forward. -
Two years after her injury, she still has chronic pain in her ankle when weight bearing, but her biggest complaint is on the medial side, just behind her malleolus (ankle bone). And, she has also developed pain behind her knee. As I’m evaluating her, I ask her to go through active range of motion and the top picture is as much plantar flexion as she could muster. And, notice she can’t curl her toes.
Passively, she has the full range of motion, so I know she doesn’t have a mobility problem. She doesn’t know how to plantar flex, but has the ability to get there if assisted. As I continue the evaluation, its obvious she has an injury to her Tibial Nerve. This nerve branches off of the sciatic nerve above the knee and runs down the back of the lower leg, behind the malleolus (Tarsal Tunnel) and into the foot. It is the exact line that she is having pain. -
Treatment includes skin drag with the Mohawk tool to free up any entrapments on the nerve, up regulation strokes to light up the Paccinian Receptors, active assisted range of motion, and finally some active range of motion exercises. -
At the end of a 20 minute treatment, you can see a change in her active plantar flexion and most noticeably, her ability to curl her toes. This will be a fun case, so keep following. This is the kind of case that @drcourtconley would love. #maximummovement - 20 minutes ago