In 2023, he sprained his left ankle while playing futsal. The sprain caused minor swelling, but it healed after a few days. However, since then, he has experienced lingering discomfort and a sensation of catching whenever he tries to bend his ankle upwards. Since there was no pain, he ignored it for several months. However, he noticed that the discomfort became more pronounced after playing futsal, so he decided to visit an orthopedic specialist. An X-ray was taken, but no abnormalities were found, so he was prescribed a topical patch and advised to perform ankle rotation exercises. Since the hospital he visited was relatively large and had a rehabilitation center, he continued to go for treatment. However, the exercises they had him do, like rotating his ankle, were things he could easily do at home, so he eventually stopped going and did the exercises on his own.

Now, nearly six months have passed, and since the discomfort still hasn’t improved, he has decided to come to my clinic.

[Examination Details]

Medical Interview

The symptom is not pain but restricted movement. There is a sensation of tightness in the left ankle, but since it did not interfere with daily life, it was left untreated. However, because the discomfort intensifies every time he plays futsal, he wanted to seek improvement and visited the clinic.

As an additional complaint, the patient also reported chronic lower back pain. The pain is dull and tends to start during desk work. It tends to ease after moving in the morning and does not bother him outside of desk work.

Visual Inspection

No visible abnormalities were observed during the visual inspection.

Static Palpation

There is significant hypertonicity in the lumbar erector spinae muscles, but no notable difference between the left and right sides.

Regarding the left ankle, when observed while lying on his back, the left ankle hangs down more compared to the right ankle (unaffected side).

Motion Palpation

In the range of motion examination, the patient reported restrictions and discomfort in dorsiflexion (upward movement) of the left ankle. During plantarflexion (downward movement), he felt a pulling sensation in the shin muscles. No significant abnormalities were noted in other movements.

Orthopedic Tests

  • Lateral/Medial Stability Test: Negative, no issues with ligament stability.
  • Foot Drawer Test: Negative, no issues with ligament stability.

Muscle Strength Test

  • Gastrocnemius/Soleus: 5/5
  • Tibialis Anterior: 4/5 (muscle is strong, but discomfort affects the evaluation)
  • Extensor Digitorum Longus: 5/5
  • Extensor Hallucis Longus: 5/5

【Treatment Summary】

Based on the examination results, it was determined that the discomfort was not related to the ligaments or tendon. Upon palpation, it was found that the navicular bone in the ankle (the ankle and hand joints are complex joints consisting of 5 to 8 bones) had shifted upwards (towards the dorsal side).

Normally, when the foot is bent upwards, these joints move downward to allow for smooth dorsiflexion of the ankle. However, in this case, the upward shift of the navicular bone was limiting its downward shift during dorsiflexion, resulting in the discomfort when the foot is bent.

The treatment began by facilitating the downward movement of the navicular bone. Restoring the movement of this bone eliminates the “stuck” sensation in the ankle during dorsiflexion. The upward shift of the navicular bone was corrected (towards reducing the medial longitudinal arch).

Additionally, muscle relaxation was performed on the extensor muscle group attached to the tibia, including the anterior tibialis and extensor digitorum muscles.

Even after the first session, the patient experienced a significant reduction in discomfort during dorsiflexion. Based on the immediate response, I informed the patient that two sessions should be sufficient for full recovery and concluded the session.

【Treatment Outcome】

2nd Visit (1 week later): During the follow-up, the patient reported that for several days after the initial treatment, he felt great and experienced no discomfort in daily activities. Although the discomfort gradually returned, it was about half as severe as before.

3rd Visit (1 week later): By this session, the patient reported that the symptoms had almost completely disappeared, and even after playing futsal, there was no recurrence of the discomfort. As a result, the treatment was concluded.

After confirming with the patient, he expressed a desire to return for treatment if symptoms reappear (some patients also seek preventative care to avoid future symptoms). With this in mind, chiropractic treatment was concluded after three sessions

【Practitioner’s Opinion】

The patient’s symptoms were typical of dysfunction in the ankle joint (specifically the navicular bone). Issues with joint range of motion are often overlooked in modern medicine, except in fields related to sports medicine. At Spine Chiropractic, I believe that even in cases involving muscle, tendon, or ligament issues, failing to consider joint range of motion and positioning can prevent accurate diagnosis and treatment of soft tissue problems.

This case demonstrated the effectiveness of the Joint Motion Treatment approach I employ at Spine. To maintain proper muscle function, it is essential to perform treatments that take joint functional anatomy into account. Without this, even repeated treatments may not lead to improvement. Naturally, painkillers or topical patches will not be effective in such cases.

If you are experiencing similar symptoms, please visit Spine Chiropractic, conveniently located just a 1-minute walk from Bashamichi Station on the Tokyu Toyoko Line(Minatomirai line), an 8-minute walk from Nihon Odori Station, a 7-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station. I will committed to providing the best care possible.