Ankle problems around the Lateral Malleolus

[iluvaaron<3]

Hi I was hoping all you fine MTs could help me out. I have an elderly client that has recently had a knee replacement. Now he is having extreme pain in his ankle (opposite side to that of the surgery). Physios aren't sure what to do with him and neither am I. There is inflamation and he is having problems walking at times. The problem is all around the lateral malleolus. :? Any ideas?

 

[princess like kitty]

Most likely he has protected the knee so much that the opposite leg has had to compensate to the point of over stressing it. Whenever I have a knee (or hip) replacement client, I end up spending a lot of time on the opposite side of the body. In your client's case, the ankle has taken the brunt of the stress - or it is showing symptoms worse/first, anyway.

For inflamation, RICE - Rest, Ice, Compression, Elevation. I would do my best to soothe the ankle, to start with. Then check peroneus longus and brevis for trigger points.

Actually, check the ROM at the ankle, and see which direction it doesn't want to go, then check the restricted muscle for TP's. The TP's can be anywhere along the leg and thigh - for starters, anyway. If one doesn't reduce, keep checking further up the leg.

 

[Pompal 09.]

Thank you Rose of Sharon!

Yes I've checked peroneus longus and brevis...found a (stubborn) TP in longus. The strange thing is it seems to be a constant inflamation! It's been going on for a least 4 months now. He also has pitted edema! :shock:

 

[...confused...]

Thank you Rose of Sharon!

Yes I've checked peroneus longus and brevis...found a (stubborn) TP in longus. The strange thing is it seems to be a constant inflamation! It's been going on for a least 4 months now. He also has pitted edema! :shock:

What are they doing about the edema? Is that on the same ankle/leg? I was taught that is a contraindication to massage, but that may have changed since I was in school.......? I'd check it out, though.

With the stubborn TP in longus, you may want to look for a TP in the hip abductors.

 

[Greek Godess]

Hi Rose...thank you! Yes I think you are right..it is a CI. It seems that the (pitting) edema is only on the ankle though...which is sort of strange. Not sure what is being done for that. He has a lot more pathological training than me & asked me to work on the leg...maybe I shouldn't though if it's a CI. :shock:

 

[CeciMoon]

more pathological training than me & asked me to work on the leg...maybe I shouldn't though if it's a CI. :shock:

Refer him out.
I see and hear less and less of we referring out when something is beyond our reach.
Pitting Edema is most certainly a contraindication.
His Dr. hopefully is doing somehting about it.
MLD may be a way to go.

Robyn

 

[livie]

His Dr. hopefully is doing somehting about it.

He is a doctor! I actually don't enjoy working on doctors for the reason that I'm never sure what to do when they themself are asking for treatment! :shock:

 

[enjoy]

His Dr. hopefully is doing somehting about it.

He is a doctor! I actually don't enjoy working on doctors for the reason that I'm never sure what to do when they themself are asking for treatment! :shock:

That would be a difficult decision!!!!

 

[Pompal 09.]

I somehow have a theme in my life..many doctors come to see me and they always ask me to do things that do not jive with my training...

 

[tessa.]

I somehow have a theme in my life..many doctors come to see me and they always ask me to do things that do not jive with my training...

That would be a scary theme. Since they are doctors, their own signature should be required for anything you have been taught is a C/I. Whatever I understand to be a C/I can't be done unless a doctor releases me to do it - and that release requires a signature. That signature releases me from liability if it turns out badly.

Of course, I and you reserve the right to say no, I am not comfortable doing that. My recommendation is ______________________.

 

[sirima b]

I think I will start getting those signatures...

 

[ezra]

Pitted edema is a CI, but only over the area, if the edema is only on his ankle, you can work the rest of his leg. Prop some pillows under his foot and calf, allowing some of it to drain, do a lot of circulatory strokes right up to the inguinal area (portal of lymph drainage for the leg) and then do trigger point work and anything else necessary, just don't work over the ankle.

Manual Lymph Drainage is not a CI for pitted edema however and can be quite helpful. If you know anyone who does it or you yourself do it, that technique will help immensely!

 

[Coriolanus]

Ankle problems around the Lateral Malleolus

Hi I was hoping all you fine MTs could help me out. I have an elderly client that has recently had a knee replacement. Now he is having extreme pain in his ankle (opposite side to that of the surgery). Physios aren't sure what to do with him and neither am I. There is inflamation and he is having problems walking at times. The problem is all around the lateral malleolus. :? Any ideas?

How is his hip on the same side as the ankle pain? The lat malleolus is a reflex area for the hip, perhaps he is favoring his knee and causing some gait problems which are showing up as pain in the ankle? I see that fairly often in my practice. HTH!