Chronic Ankle Sprain

Volume: 1
Issue: 9
December 15, 2006
Chronic Ankle Sprain

Dear Colleagues:

The acutely sprained ankle is not a difficult thing to treat. In most cases, elevation during the first day or two, taping and early mobilization does the trick. Within a few weeks, normal activity can usually be resumed.

Why is the sprained ankle not healing?
However from time to time, the natural course of events is delayed or even arrested. After several weeks, considerable swelling is still present and the ankle is painful to use. When this occurs the question should be asked: what is impairing normal healing?

Osteopathic physicians usually recognize that untreated somatic dysfunction is present. In other words, there is a local mechanical dysfunction accompanied by a local autonomic nervous system reaction. The usual culprit is the distal fibula which is displaced slightly anteriorly, posteriorly or inferiorly, relative to the rest of the ankle bones. The displacement corresponds with a restriction of movement in the opposite direction, e.g. a posterior displacement of the distal fibula limits the ability of the fibula to move anteriorly, thus disturbing the mechanics of the whole ankle.

Displacement of the distal fibula cannot normally be detected by x-ray. The mobility and position of the fibula must be assessed by palpation, not an easy task for untrained hands. When somatic dysfunction is diagnosed, various manipulative techniques can be used to restore normal position and movement of the fibula. The response is almost immediate. Patients, often athletes or dancers, are immensely appreciative.

Neural therapy can fix it!
For those not trained in manual diagnosis or manipulation, neural therapy is an alternative method of treatment. It is very simple and is as effective as manipulation. But before describing its application, a few words about its rationale:

The displacement of a bone (or part of a bone) does not occur in a vacuum. The soft tissues connected to the bones determine where the bones sit and the tension in the tissues are regulated at least to a degree by the autonomic nervous system. As in the spinal column, neural therapy of the soft tissues surrounding the dysfunctional joint can correct the position and restricted movement of the joint. The technique, (described in my book) is the injection of “quaddles” or blebs of dilute procaine into the cutaneous or subcutaneous tissues overlying the area of concern, followed by a small bolus of procaine into a vein on the same side of the body as the joint being treated. In the case of the ankle, the quaddles are placed over the swollen area on the lateral aspect of the ankle.

The response is usually immediate: normal ankle movement is restored, pain is reduced and the swelling settles not long after. Usually only one treatment is required.

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