Case: 60 Year Old Female with Ankle Stiffness
A patient recently came to see me four days following her ten day beach vacation. She explained that she did 5 kilometres of walking along the beach daily. On the ninth day of her trip, she found it very difficult to walk, due to a restriction/locking in her ankles. She wore flip flops, sandals and sometimes went barefoot on her walks. As much as she tried, she could not bend her ankle/foot up or down. She explained that she was worried that she broke something in her ankle and thus the cause of her limited motion. During the airplane ride back, she noticed some swelling in both the ankles and immediately became concerned. When she returned home, she went to see her family doctor right away about the health concern. Her family doctor did some blood work and requested x-rays of the ankle and foot. Everything came back normal. The doctor suggested she go to a Chiropractor or Massage Therapist.
When she showed me her ankle, it appeared to be slightly swollen and was fairly tight/restricted. Her ankle range of motion was limited 50%. Although she could walk, she found it difficult to do so not due to pain, but to limitation in ankle movement. She had no problems bearing weight on her ankles. After a history and physical examination, we had ruled out infection, fracture, tumor, compartment syndrome and other serious health conditions/concerns.
After doing some research, this seemed like a sprain of a ligament in both her ankles. However, what type of ankle sprain grade did this fall under AND what could cause such a sprain?
According to the Medscape Ankle Sprain Grading:
Grade 1 injuries involve a stretch of the ligament with microscopic tearing but not macroscopic tearing. Generally, little swelling is present, with little or no functional loss and no joint instability. The patient is able to fully or partially bear weight.
Grade 2 injuries stretch the ligament with partial tearing, moderate-to-severe swelling, ecchymosis (bruising), moderate functional loss, and mild-to-moderate joint instability. Patients usually have difficulty bearing weight.
Grade 3 injuries involve complete rupture of the ligament, with immediate and severe swelling, ecchymosis, an inability to bear weight, and moderate-to-severe instability of the joint. Typically, patients cannot bear weight without experiencing severe pain.
-Source for Ankle Sprain Grading – Medscape
After careful consideration of each sprain grade, none fit her profile and condition well. If any, the grade 2 ankle sprain came the closest. The patient did not sustain an injury, did not have any bruising and was able to bear weight on her ankles. She did have moderate functional loss of the ankle joint (ankle mortise – see picture above) and slight swelling.
Is this a classical ankle sprain or is this something different?
The patient explained that this condition happened to some of her relatives back in Europe. She went on to describe that sometimes when her relatives walked along the beach for a long time (with or without shoes), they experienced three to four days of restriction and what she called “impacted ankles”. I never heard of this term used in this fashion before. After further review of the literature, the only information I came across in regards to impacted ankles was associated with ankle fractures, which we ruled out.
When I felt the ankle joint, I noticed that it was not moving well. The ankle mortise joint (joint between the tibia and talus), felt locked on both sides. Furthermore, the other bones below the ankle (tarsal bones and metatarsal bones) before felt locked, tight, and restricted.
I proceeded with some electrotherapy, therapeutic ultrasound, soft tissue therapy and an ankle adjustment. As soon as I finished, she felt relief and felt that both her ankles were much looser. I retested her ankle range of motion and noticed a 25% improvement. The patient came back the next day and received the same treatment. After the third treatment session, the patient explained that she was 100% better and had retained full function in her ankles.
It appears that this health condition experienced by my patient is different from the classical graded ankle sprain. It seems that the patient did in fact “impact” or lock her ankles somehow. Perhaps, this was due to a increase in walking or from walking on the harder sand near the shoreline. Perhaps, it was due to improper or no footwear at all. The direct cause, in her scenario, remains unknown.
I look forward to any comments in regards to this health concern.
Dr. Luciano Di Loreto, HBSc., D.C.
Chiropractor and Acupuncture Provider
Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.
Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.