Safety of mobilization in treatment of ankle with ligament tear?
I wonder if I could get some view of yours.
I´m a female in my thirties. In 2016 I underwent some podiatric physiotherapy, first because of metatarsalgia in my right foot. Pain and irritation transferred soon from frontal foot to more behind part, laterally in front of the ankle. Eventually I had orthotics made because of the symptoms.
In the summer 2017 I had my foot almost symptomless. But then in autumn 2017 a stupid event happened. My physiotherapist asked if I would undergo some clinic visits as a practise customer for one physiotherapy student he was guiding. He knew my foot was already in okay condition and I had stupid trust.
Trainee did manipulative traction on my both upper ankle joints, three quite strong pulse-type pulls on each ankle.
Some 30-40 minutes after this I started to feel pain in my right ankle, area of outer malleolus.
Pain spread also to the lateral instep. During this acute period, my foot had more pain than during my former rehabilitation period. There was tearing and pricking sensation when foot had load. Also pulsating pain and tingling when in rest. Since this, the main symptom point has been the front border of lateral malleolus. Physiotherapist inspected my foot two weeks after the handling. His explanation was tissue soreness and ankle capsule irritation. He stated that no injury could have happened, not even with strong pulls.
Having still some symptoms, I had an MRI scan of my foot six months after ankle traction. FTA-ligament was very thin but uniform, and FTP-ligament had some fraying. The diagnose was ligament tears. But I haven´t had any sprains with my ankles!
Hospital physiotherapist stated that if the ligaments had already some embrittlement, traction as a quite strong technique could have possibly torn the ligaments more.
Now I´m rehabilitating my ankle with a new podiatrist. I did tell him how the symptoms in the FTA-ligament area started. During my two appointments he has found stiffness in my lower ankle joint (right foot). He has mobilized it with slow, more controlled pulls, using some light fabric around my ankle to pull with. He said he wouldn´t do traction technique. Now after the second appointment, couple days ago, I think that irritation in the FTA-area has been stonger and there was some pain too. Not as much as after traction though.
I´m wondering, if FTA-ligament is possibly still “very thin”, is there a risk that even a slow pull can thinner it even more? Should the stiffness in lower ankle joint just let be there, unmobilized, if it feels that FTA gets more irritated after mobilization? Could there be something in my ankle´s structure that causes too much pull for the ligament when doing mobilization pulls?
Thank you for making the effort to read this, and if you can share some of your first thoughts!
36 day(s) ago