Persistent ankle discomfort and restricted dorsiflexion after a futsal-related ankle sprain

In 2023, the patient sprained his left ankle while playing futsal. The injury caused mild swelling, which subsided within a few days. However, he continued to experience discomfort and a catching sensation when dorsiflexing his left ankle.

Because he did not experience pain and the symptoms did not interfere with his daily activities, he initially did not seek further treatment. However, he noticed that the discomfort became more noticeable after playing futsal, particularly with repeated use of the ankle.

He subsequently visited an orthopedic clinic, where an X-ray was taken. No significant abnormalities were identified. He was prescribed a topical patch and advised to perform ankle mobility exercises, including ankle rotations.

He continued attending the clinic for treatment for a period of time. However, he felt that the exercises he had been instructed to perform were simple enough to do at home, so he eventually stopped attending and continued the exercises independently.

Nearly six months later, the restricted movement and discomfort had not improved, particularly after playing futsal. He therefore decided to visit our clinic for further evaluation.

[Examination Details]

Medical Interview

The patient’s primary complaint was not pain but restricted movement and discomfort in the left ankle.

He described a feeling of tightness and catching when bringing the ankle into dorsiflexion. Although the symptoms did not affect his daily activities, they became more noticeable after playing futsal and had persisted for approximately six months.

As an additional complaint, the patient reported chronic lower back pain. The low back pain was described as dull and tended to develop during prolonged desk work. It generally improved after getting up and moving around, particularly in the morning, and did not significantly bother him during other activities.

Visual Inspection

No obvious swelling, deformity, or other visible abnormalities were observed.

When the patient was lying supine, the left ankle rested in a more plantarflexed position compared with the right ankle.

Static Palpation

Significant hypertonicity was noted in the lumbar erector spinae muscles, with no marked difference between the left and right sides.

No significant tenderness or other notable findings were identified around the left ankle during static palpation.

Range of Motion and Motion Palpation

Left ankle dorsiflexion was restricted and reproduced the patient’s characteristic discomfort and catching sensation.

During plantarflexion, the patient reported a pulling sensation in the anterior lower leg.

No significant abnormalities or discomfort were noted with the other ankle movements.

Orthopedic Tests

  • Ankle ligament stability testing: Negative.
  • Anterior drawer test: Negative, with no apparent indication of significant lateral ankle ligament instability.

Muscle Strength Testing

  • Gastrocnemius/Soleus: 5/5
  • Tibialis Anterior: 4/5 — strength testing was limited by the patient’s discomfort.
  • Extensor Digitorum Longus: 5/5
  • Extensor Hallucis Longus: 5/5

【Treatment Summary】

Based on the examination findings, there were no clinical signs suggesting significant ligament instability or a clear muscle weakness pattern contributing to the patient’s symptoms.

During palpation and assessment of joint motion, the navicular bone of the left foot appeared to be positioned more dorsally than expected. The navicular is one of the bones that contributes to the complex structure and movement of the foot.

Normally, coordinated movement of the bones within the foot allows the ankle and foot to move smoothly into dorsiflexion. In this case, restricted movement of the navicular appeared to be limiting the normal mechanics of dorsiflexion, which reproduced the patient’s characteristic discomfort and catching sensation.

Treatment initially focused on restoring the mobility of the navicular and facilitating its downward movement. The joint position and movement were adjusted with the aim of improving the functional mechanics of the medial longitudinal arch and allowing smoother dorsiflexion.

Soft-tissue treatment was also performed on the extensor muscle group of the lower leg, including the tibialis anterior and extensor digitorum muscles.

Following the first treatment, the patient reported a significant reduction in discomfort during dorsiflexion. Based on this immediate response, I explained that only a small number of treatment sessions might be necessary if the improvement continued.

【Treatment Outcome】

Second Visit — 1 Week Later

At the follow-up visit, the patient reported that his ankle had felt very good for several days following the initial treatment, with no discomfort during his daily activities.

Although some of the discomfort gradually returned, he reported that it was approximately 50% less intense than before the initial treatment.

Third Visit — 1 Week Later

By the third visit, the patient reported that the symptoms had almost completely resolved.

Importantly, he had also played futsal without experiencing a recurrence of the discomfort.

As the patient’s symptoms had resolved and normal activity had been restored, treatment was concluded after three sessions.

The patient was advised that he could return for further evaluation if the symptoms recurred. He also understood that some patients choose periodic chiropractic care as part of an approach to maintaining joint mobility and function.

【Practitioner’s Opinion】

This case illustrates how restricted joint motion can contribute to persistent ankle discomfort following an ankle sprain.

Although the initial injury had occurred almost six months earlier and the swelling had resolved within a few days, the patient continued to experience a catching sensation and restricted dorsiflexion. Standard imaging did not identify any significant abnormality, and ligament stability testing was negative.

From a chiropractic perspective, assessing the functional movement of individual joints within the foot can provide additional information when a patient continues to experience movement-related symptoms despite the absence of obvious structural abnormalities.

At Spine Chiropractic, I use the Joint Motion Treatment approach to assess and address restrictions in joint movement while also considering the surrounding muscles, tendons, and ligaments.

In this case, treatment focused on restoring movement around the navicular and improving the functional mechanics of the foot. The patient’s immediate improvement following treatment, followed by continued improvement over the subsequent two weeks, suggests that restricted joint motion may have been contributing to his symptoms.

This case also highlights an important point: when a movement-related symptom persists, it may be useful to assess not only the muscles, tendons, and ligaments but also the movement and functional positioning of the joints themselves.

If you are experiencing persistent ankle stiffness, restricted dorsiflexion, or discomfort following an ankle sprain, Spine Chiropractic is conveniently located just a 1-minute walk from Bashamichi Station on the Tokyu Toyoko Line/Minatomirai Line. We are also approximately 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.