Pes Cavus:Astragalus on left foot rigid

[NZgirl]

Hi there,
I am a New Zealander living in Spain so as I am being treated in Spanish please forgive any vocab mishaps as strangely enough I'm not sure of all the correct terminology in English!
My situation is...
I have pes cavus and at the ages of 10-12 had surgery on both feet to lengthen the tendons. Before the surgeries, when I was about 7yrs old I badly sprained my left ankle and had to have it in a plaster cast. Subsequently over the years I have sprained my left ankle about 5 times and it has always healed without problems. After 10 sprain-free years I sprained my left ankle in Oct 2006 (although I didn't fall or twist the ankle, it was after an afternoon playing with the kids in the park I left the park with a sore ankle and it became swollen, I assumed I had sprained it without realizing). I treated the ankle with ice and rest and bandaged it and carried on as best I could. In February 2007 I realized I hadn't regained all movement in the ankle and went to Physio. She suggested exercises to do at home. This was unsuccessful and due to family obligations I didn't return to Physio until September 2007. When I returned in September the left ankle was very rigid and I could barely flex it upwards. After 4 months of physiotherapy and one month of acupuncture and homeopathic injections in the ankle I have gained a lot of movement. All of the smaller bones in the foot that previously didn't move now move and are flexible.

However, The Problem:
I can only flex my foot to a 70-75 degree angle (before the sprain in October 2006 I had a normal 90 degree flex).
When I flex my foot up the foot reaches 75 degrees approx and then turns inwards as the astragalus is flexible on the inside of the foot.
The astragalus is rigid and reaches a "top" where the bones are hitting each other, on the outside of the foot.
(Once again please excuse my explanation as I am so used to talking about this in spanish).
So I am left with one specific point in the ankle joint where the bones seem to be hitting each other and this impedes the foot from flexing upwards.

My Question:
How can I somehow soften the bones so the physiotherapist is able to manipulate them to gain some movement. I have had homeopathic injections that freed up the other bones in the foot and I am still having the injections in the ankle joint in the hope that it helps.
Are there any other options (besides surgery as this would be a last course of action for me, I also have osteopenia) that can be used to get the bones moving and create space in the ankle joint so the foot can be flexed to a normal 90 degree angle?

Any advice or suggestions would be very much appreciated.
Thanks for your patience as this seems to be a long post!

thanks
Anna :-)

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[Canuck Physio]

Hello,

Do you still do physiotherapy exercises, including stretching? It appears that your ankle range of motion has been restricted for a very long time. In any case this would lead to considerable shortening/lengthening of the muscle groups around the ankle.

From what you describe you have a bony block to movement upon plantar flexion?

If this is the case you may need to lengthen specific muscles to give you the range of motion necessary for full flexion.

[NZgirl]

Hi
Thanks for the reply, yep I'm doing stretches and I have two physio sessions a week plus two pilates sessions.
What I'm trying to work out is how to get the bones moving at the point where they are completely rigid, the physio says the ankle joint at that point is stuck, is that technically a bony block? And how do you unblock a bony block???....I wish I knew as my knee and lower back are also suffering as a result :-(
Anyway thanks for the help
Anna

[Canuck Physio]

Hi
Thanks for the reply, yep I'm doing stretches and I have two physio sessions a week plus two pilates sessions.
What I'm trying to work out is how to get the bones moving at the point where they are completely rigid, the physio says the ankle joint at that point is stuck, is that technically a bony block? And how do you unblock a bony block???....I wish I knew as my knee and lower back are also suffering as a result :-(
Anyway thanks for the help
Anna

Hmm...

You haven't mentioned whether or not you use orthotics, or modified foot wear. If you do, does it help?
Does the Physio you see do manual work with the foot/ankle region? As you perhaps already know hands on manipulation is primarily needed here. Naturally in Pes Cavus the foot remains arched meaning that on the base or plantar side of your foot, the soft tissue will naturally shorten, tighten, and adhesions may occur. This would obviously require regular care involving massage, perhaps heat therapy.

You mention several previous ankle sprains, I wonder if any ongoing treatment is being done for this relatively hyper mobile joint.

Hopefully someone on the board who is a foot specialist can contribute.

[NZgirl]

Yes I do wear orthotics and it helps a lot so I can walk in shoes, more or less well at the moment but with a slight limp.
The physio is doing hands on manipulation as that is how we managed to mobilise the joint to the point it is now, but what we don't know how to mobilise it further right now.
The acupuncture and homeopathy has cleared a lot of the adhesions, I'm wondering if there are adhesions deep in the joint preventing it from moving, as I have a lot less space there than the average foot it would just need to be a small adhesion to stop it from moving?
Anyway thanks again for your help.
Anna :-)