Pain on top of foot near ankle when walking

52 year old woman. Complains of sharp pain on top of foot when walking, localized near the outer ankle on the right side (deep and severe when moving). Has been bothering her for about two months, does not remember the cause and onset.

Objective examination: little swelling below and in front of outer ankle. Active and passive supination of the foot is limited by pain, especially bringing the heel inward. The remaining movements in the foot are painless, including axial loading. In addition, there is asymmetry of the pelvic bones with posterior rotation of the iliac bone on the right and blockage of the right sacroiliac joint. During dorsal displacement of the distal edge of the fibula, symptoms decrease until they disappear completely.

Diagnosis: dysfunction of the distal fibula-tibial joint and associated joint dysfunction of the foot. Posterior rotation of the iliac bone.

Treatment: muscle-energetic techniques for the pelvis, mobilization with active movements of the external ankle, use of the fixation patch for the whole day after treatment.

Results: after three sessions full disappearance of habitual pain when walking. Attempts to reproduce symptoms by bending the heel inwards don't cause pain.

Top of foot near ankle hurts when walking. Conclusions.

The case of treating a recent problem. The relationship between the impaired mobility in the foot and in the pelvis is of interest. Which came first? Or did the pain on top of foot near ankle cause a protective compensatory response above, in the form of limiting pelvis mobility on the painful side. Or, the pelvic impairment caused an overload in the foot and changed the joint mechanics, which was further aggravated by being overweigh and hurts when walking even more. Both variants have the right to exist.

Grigori Tafi
Osteopath, sports medicine doctor
15 years of experience in osteopathy and manual therapy. Read more...

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