This is a case study of an amazing achievement of success taking a young lady from a lifetime of restriction to a full freedom in her movement.
If you have read other articles I have written you may have noticed how important I consider biomechanics are to a pain free and active life. This case study confirms this. I have written this article with permission from my patient, though I will keep her anonymous and Call her Miss A.
This 33 year old lady attended with pain in the medial aspect (inside) of her knee, no injury had occurred. She is an office worker and attends the gym regularly for keep fit classes and workouts using machines.
She was born with a club foot also known as talipes, it is a birth defect that can affect one or both feet. Treatment is undertaken at a very early age including plastering the leg/s and splints to alter the position of the foot. Miss A had one foot/ ankle affected and underwent years of wearing plaster of Paris and also had an achilles tenotomy – where the achilles tendon is cut in a zigzag pattern which enables it to lengthen, this allows the ankle range to be improved. When she queried if there was any more to be done as she grew up she was made to feel like she should be happy her foot pointed in the correct direction.
Upon examination Miss A’s knee was normal apart from a condition called a pes anserine bursitis – this is a small sac of fluid protecting 3 tendons which attach on the inner side of the tibia just below the knee joint. During the examination I also noted her ankle which was significantly restricted in range – about 90% reduction of movement on dorsiflexion (bending the ankle up), also inversion was restricted by 50%. On the same foot the big toe joint was also severely restricted with the flexor hallucis longus tendon extremely tight and zero big toe extension.
This restriction in her biomechanics had in my opinion caused the irritation of her knee bursa. I proposed that I would treat her ankle to solve the cause of her problem not just the symptom. When I examined her ankle I also felt the flexibility could be increased significantly with the correct manual therapy treatment.
I utilised hands on mobilisations and manipulations of the talocrural (ankle), subtalar joint (between the talus and calcaneum (Heel) and metatarsophalangeal great toe (big toe) joint. I also advised Miss A on specific stretches for both the calf muscles and the flexor Hallucis Longus.
The results have been fantastic, going from a 90% reduction range we have achieved an almost full range of motion in both the ankle and the big toe allowing significantly improved biomechanics, normal walking and she’s even super keen on running though I have advised to be very careful due to the tenotomy on her achilles and she is currently training on cross trainer and gym classes.
Miss A is so happy we have succeeded in giving her the range of motion she has never had before.
You require help with your biomechanics or any aches and pains Call Lia on 01962714979.