Expert: Dr. Victor Dolan, DC, DACBSP - 7/31/2008

Question
QUESTION: I fell down from two foot height and landed unevenly on a concrete surface I injured my ankle three weeks ago. There was immediate swelling at my left toefingers but no bruise.  I went to the doctor two days after and he said that it was just a bad sprain. But the severity of the pain was same so i went to another doctor after 10 days and X- ray report came negative.I am feeling pain at the fifth metatarsal bone of my left ankle. I am on crutches since three weeks though there is no fracture at fifth metatarsal bone. The pain is less compared to the first week now but I don't know whats going on in my ankle. can anyone tell me what could be the problem in my ankle.? what should i do in order to heal faster?
The pain is coming from base i.e head of the fifth metatarsal bone, some what at joint  i.e stable zone and pain is persisting to the inside of the ankle ligaments that is making me unstable to stand and bear any weigh

ANSWER: Hello Baba,

Persistent pain such as this is due probably due to fracture or dislocation.  Have you seen the proper doctors?

A podiatrist with some type of sports injury practice may be a good doctor to visit; if not the DPM (podiatrist with sports injury certification), then an orthopedic MD.   Orthopedic MDs often have different specialties; some do hands, some only do knees, some do hips, etc.,  do a yellow page search, google search, talk to your friends,,, is there an orthopod who specializes in foot/ ankle in your area?- go to that specialist.

Given persistent pain, perhaps additional testing along with additional examination should take place.  An MRI may be helpful given your continued complaint.

Another good, different choice for evaluation would be a Doctor of Chiropractic with a sports injury certification (CCSP, DACBSP) or an orthopedic certification (DACBO).  Your pain is persisting.  It is time for another different professional, perhaps a different profession to look at you.

A little late, but a handout I utilize for most injuries in my office:

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P.R.I.C.E. =    P  protection.   R rest.   I  ice.   C  compression.   E  elevation.
Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??
You should certainly get to the Doctor or trained health professional to be looked at if you think it is bad enough.    BUT in the meantime, some simple steps may help. PRICE.
The  PRICE  protocol will usually help just about any musculoskeletal injury.
P = Protection;  protect the area from further injury- stop what you are doing, can you
     pad  or bandage the area ? Tape the area? Do something to protect the area !
R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to
       repair the area
I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control
     (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
     injured area for 30 minutes; then back on again
C = Compression;  to help prevent swelling compression may be helpful- for example
      if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body
      parts may not be applicable to compression.
E = Elevation; again to fight swelling and pain, raising the injured body part above the
      heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part
PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion
Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!
         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.

This is a serious condition identified by its five parts:
    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
    Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!
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I hope this gives you some ideas.

I wish you good luck, and good health naturally!

Dr. Victor Dolan, DC, DACBSP
http://drvictordolan.chiroweb.com      (email newsletter)
http://www.GoodHealthNaturally.info
http://www.DocDolan.net




---------- FOLLOW-UP ----------

QUESTION: I am feeling pain just under the cuboid region of the fifth metatarsal bone. It has been 4 weeks now and i am still feeling the same intensity of the pain as i had first week. I went to three doctors and had X-rays three times but the report came negative. I am putting partial weight on left ankle with boot and crutches. none of the doctors are able to figure out the possible problem, I don't know what to do now. Please tell me what could be wrong and suggest me some precautions that i have to take.

Answer
foot pain, ankle pain, subluxation,

Hello again Baba,

Sounds like you have done ALMOST everything you can do.  You have had repeated Xray with negative results.  With continued pain such as yours, perhaps an MRI would also be helpful.  MRIs look at things other than bone- joint spaces, tendons, ligaments, muscles, cartilage can be imaged through MRI and find a non-bone cause of your problem. If not an MRI, musculoskeletal diagnositic imaging ultrasound may also be helpful in locating the source of your problems.  The MRI is probably easier to get performed, from an availability viewpoint, and from an insurance re-imbursement viewpoint.

Besides these traditional advanced views, I again recommend a Doctor of Chiropractic with a DACBSP, or DACBO credential.  Your source of pain may NOT be a fracture, may not be a frank dislocation, but may be just a slight misalignment- - - known in chiropractic as a joint subluxation.  Even a 'little' subluxation can provide severe noxious stimuli (pain).  The Doctor of Chiropractic looks for the subluxation with static palpation, motion palpation, imaging modalities.  Other professins do not place such an importance upon proper alignment and movement patterns as does Chiropractic.

I have explained spinal vertebral subluxation complex in the previous answer, but subluxation can take place at any joint.  You may have a subluxated joint in your foot- see a DC, i.e.: be examined for a 'dropped cuboid' or other subluxed bone/ joint in your foot.
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Subluxation  (any joint) :

Kinesiopathology:
        This is fancy way of saying the bones of that joint have lost their normal motion and position. It restricts your ability to turn, move and bend. It sets in motion the other four components.

   Neuropathophysiology:
        Improper joint function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction alters proprioception and can cause symptoms elsewhere in the body.

   Myopathology:
         Muscles supporting the joint can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated joint adjustments to provide proper alignment and motion.

   Histopathology:
        A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Joint capsules can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage. Chemicals of inflammation can irritate and inflame neighboring structures, creating a vicious cycle.

   Pathophysiology:
        Bone spurs, calcium deposits and other abnormal bony growths attempt to fuse malfunctioning joints. This joint deterioration, scar tissue, and long-term  dysfunction can cause neighboring structures to malfunction and deteriorate and other systems of the body to malfunction.
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Precautions?- activities as tolerated.  Hurts?= do not do it.  Slow return to normal activities of daily living.  Continued use of crutch/ cane as needed.  Foot up when possible. No salt.

My recommendations:  further imaging, and your local Doctor of Chiropractic with DACBO or DACBSP credentials.

At my Staten Island Chiropractic office we do treat extremities with regard to the impact upon the spinal complaints of the patient.

Again, I wish you good luck, and Good Health Naturally.

Dr. Victor Dolan, DC, DACBSP
http://drvictordolan.chiroweb.com    (email newsletter)
http://www.GoodHealthNaturally.info  
http://www.DocDolan.net