Joint Dysfunctions: Help Through Mobilization Procedures

Blogging on Tuesday is Email Correspondance 

      Melanie and I have been working on her foot and ankle problem for the last 6 months. There was a component of nerve pain, called Tarsal Tunnel Syndrome, but she really responded more to anti-inflammatory, and less to nerve, treatments over all. I had emailed her after several months of not hearing how she was doing and this was the reply I got. Melanie is a typical sports medicine patient whom takes ownership in her problem and deals with it. I am highlighting her email since it represents a group of my patients who do extremely well with joint mobilization. And, it is normally not I who recommend it, but a body worker or physical therapy.


      I once had a patient Olivia (real name for once) who longed to be a professional ballerina. She even lied about her age so the San Francisco Ballet School would accept her. Well, Olivia was one day away from ankle surgery since I was convinced an extra bone in the back of her ankle (os trigonum) was causing her pain. I tried 6 months of physical therapy and could not get her better. Two days before her surgery she accompanied her friend to the friend's chiropractic visit. The friend asked if the chiropractor would look at the ankle. All I know was that there was some adjustment done, and now 20 years later, she has never had to have surgery. She had a great 16 year career in ballet, and now is the mother of three. I still see her mom and get the updates. I grew up a little more the day we cancelled Olivia's surgery. 

Hi Rich,

Thanks for your email.  As a diagnostic tool, about three weeks ago I went swimming for a little bit,  because last fall it felt really good to swim and I wanted to see a little more what was going on now.  I was also feeling that, although you were able to diagnose tarsal tunnel syndrome, I felt like I never really knew what the underlying root cause of that condition was, and that seemed to be a missing piece in the puzzle.  Anyway, my tarsal tunnel area and the arch of my foot both did really well during and after the swimming, but I had some pain through a low horizontal plane in the front of the foot (at about the talocrural joint).  So, that raised a question for me about maybe there was something else going on that was the root of the tarsal tunnel syndrome.

Shortly after that episode of swimming, I saw a person who indicated that my talus bone was out of alignment and he did an adjustment to bring the talus bone back into alignment.  This adjustment brought immediate relief in walking, without the boot and without any Aleve.  I was able to walk normally a short distance without pain (I didn’t push it), althought there was significant weakness of course.  Over the next couple of weeks after that, I have been doing rehab exercises including walking, balancing on one foot, and stretching (calf/achilles).  I have worked up to walking 20 minutes each day, in flat shoes, without pain (I started at 10 minutes per day, adding about one minute per day).  Now I am going to add 10% more walking time per week.  Interestingly, he also said that I should continue to walk in flat shoes and not point my toes for the time being, and that the rehabilitation should take 6-8 weeks.  He also said that the nerve activity, which is very minor now, will die down completely on its own within about nine months.

One question that I have is – would you be able to see an alignment problem like this on an MRI? 
Dr Blake's comment: I am not sure if you can ever document these joint dysfunctions on X-ray or MRI. 


  Anyway, I am hopeful that this approach will result in a full recovery in a fairly short period of time, but if for some reason it doesn’t, I might ask for your help again.  I am appreciative of all the things you have done to try to help me before this.  Thank you for that.

Melanie