An Unsanctioned Coalition: Ankle Diagnosis

Alternate Title: Why my physiotherapist couldn’t get that bone mobilized.

It’s funny that after 5 years of constant therapy involving 4 doctors, 12 sprains, 4 Xrays and 2 MRIs, somebody has finally found something that can be deemed “wrong” in my right ankle! Despite all the history my right ankle and I have together, we’ve never received a diagnosis that explains our dysfunctional relationship.

I have a fibro-osseous tarsal coalition between the anterior process of my calcaneus and navicular bones. Put simply, the cartilage between these two bones of my foot hardened into a mature bone bridge that immobilizes the joint.

Knowing how frustrating and restricting chronic pain and injuries can be, I’d like to share my experience to help all those of you who may have experienced similar injuries to assist your own diagnoses!

Table of Contents

  1. (a) Background information on this condition, (b) My Ankle’s History
  2. Symptoms
  3. Diagnosis
  4. Treatment Options
TC
Image: OrthoInfo

1a. Background Information

Tarsal coalitions are the result of a gene mutation and are present at birth. The condition is often not discovered until puberty. Some cases are never diagnosed if the foot’s movement is not seriously impeded and symptoms never present. A coalition can form between any of the foot’s tarsal bones, resulting in a full or partial fusion between them. This coalition results in a stiffened hindfoot, putting undue stress and pressure on the other parts of the foot. The condition can be worsened by intense/weight-bearing activity.

My particular tarsal coalition, between the navicular and calcaneus, manifests in inner foot pain in the area circled.

2016-08-19 19.38.50

 

This information was learned from my sports medicine doctor and the reference (OrthoInfo) she provided.

1b. My Ankle’s History

Over the past five years I have sprained my right ankle over 10 times. I haven’t been able to run once over these 5 years. Initially, these were sprains from high-impact falls or dramatic rolls from running. These first sprains sent me to the hospital for Xrays that never showed much of anything. A later MRI suggested a previous, undiagnosed fracture. Over time my ankle pain became more chronic, and sprains became more frequent. My ankle would go through periods of relentless ache, then a couple months of relief before the next sprain. Often I would miss the summer climbing season due to an untimely sprain.

From the beginning I saw my physiotherapist, and practiced my strength and balance exercises quite diligently, I must say. My physiotherapist suggested that a displaced cuboid bone in my foot may have been the root of this chronic cycle. I began seeing a chiropractor, who brought me to tears with the first real relief I’d ever felt from the pain. After 6 months of her treatments combined with ongoing physio exercises, I managed to regain a strong, stable ankle that lasted most of the year. However, a dynamic fall while bouldering brought everything tumbling back. By the end, it took little less than an unfortunately executed step to “sprain” my ankle.

I began to develop really debilitating pain and swelling in my inner foot, rendering the few gentle spin bike and lower body exercises I could still do unbearable. Working a summer job that has me on my feet full-time, this evolved into a constant sharp ache. This was diagnosed as both plantar fasciitis and weak arches. My physiotherapist was concerned about the hypermobility of my cuboid bone and the hypermobility of my navicular joints during her assessment. Now, my chronic history makes sense in light of the reduced mobility of my foot.

2. Symptoms

From OrthoInfo:

  • “Stiff, painful feet. The pain usually occurs below the ankle around the middle or back half of the foot.
  • A rigid, flat foot that makes it difficult to walk on uneven surfaces. To accommodate for the foot’s lack of motion, the patient may roll the ankle more than normal, which may result in recurrent ankle sprains.
  • Increased pain or a limp with higher levels of activity.”

Personal experience:

  • swollen inner edge of foot–tender to touch
  • inflamed, ropey plantar fascia
  • bone marrow edema

3. Diagnosis

Tarsal coalitions can be diagnosed using an Xray, MRI or CT scan. Often a traditional ankle Xray is not conducted on a plain that provides good visibility of the affected area, and may not pick it up. An MRI or CT scan may provide better angles/visibility.

4. Treatment Options

  1. Traditional: Orthotics, Physiotherapy & Rest.
  2. Pain Relief: Steroid Injections can yield temporary pain relief.
  3. Surgical: Resection or Fusion surgery. Reference OrthoInfo

Despite my extensive history of physiotherapy and chiropractic treatment, I have never undergone treatment specific to this condition. My sports medicine doctor has prescribed custom orthotics which will hopefully relieve the pain, inflammation and pressure. I will work to develop a condition-specific program with my physiotherapist, and monitor my progress. Should the symptoms worsen, surgery may become an option. However, surgeons are hesitant to operate since I am still growing and the joint shows no signs of arthritis.

I hope my history can help alleviate yours!

Cheers, and please feel free to ask questions/add comments below.


Reference: “Tarsal Coalition-OrthoInfo – AAOS.” Tarsal Coalition-OrthoInfo – AAOS. American Academy of Orthopedic Surgeons, n.d. Web. 19 Aug. 2016

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