Keith, a 77 year old male patient who was new to the area came to see us with an ingrowing toenail. We booked him in for the customary half hour new Chiropody appointment slot and I was able to sort the nail out within 10 minutes.
“Anything else bothering you footwise?” I ask.
“Well, I’ve got this arthritic ankle but there’s nothing you can do about that is there!”
“Who told you that?”
“Oh, I’ve seen an Orthopaedic surgeon who X-Rayed it and said it was Osteoarthritis (OA) but there was nothing that an operation would help. He sent me to physio and they said there was nothing that could be done….Why? Is there something you can do?”
“Has anyone tried mobilising the joints?”
Foot Mobilisation Therapy (FMT) helps to improve movement in joints. More often than not, after an FMT session, patients perceive that their foot joints feel ‘freer’ and that their pains have reduced. Bob and Lee did the training course with Aussie FMT guru Ted Jedynak in 2017 and have used it to great effect every working day since.
As we had some spare time, I worked on mobilising Keith’s ankle and much to his delight, on standing, it was less painful and he requested a follow up appointment.
On return he reported that the ankle had felt better than it had for years and wondered how can that be? Surely the arthritis is the same?
Indeed, if you had taken an X-Ray before and after treatment it would show no difference. Clinically however, you can feel that there is more movement within the joints after FMT.
OA is a funny thing. You could have X-Rays of 2 arthritic knees that look exactly the same, yet one person will be in lots of pain with it, and the other not even aware that they have it.
The degree of arthritis can play a role in how effective FMT can be. If a joint is rigid (or close to it because of bony changes) then probably nothing will help except fusing or replacing the joint. But if there is movement available then FMT can have a profound effect.
We are talking about chronic pain here (ie pain that’s more than a few months old). This is a great video explaining what chronic pain is. It can be hard to believe that your painful ankle is your brain telling you that it hurts so you’ll protect it.
FMT is thought to work in different ways. It moves the bones in such a way that allows fluid back into the joint. The cartilage that keeps the bones apart and protects them is normally full of fluid. This fluid slowly seeps out when a joint is loaded and back in when it unloads. In arthritic conditions, due to how the joints are loaded, this fluid seeps out but doesn’t have a chance to re-enter meaning the joint is not as well protected and damage can start to occur.
With this damage there often comes pain. It is your brains way of protecting damaged tissues. FMT puts your joints through their accessory movements (movements available to the joint that the body itself cannot access). By manually moving the joints in this way, local nerves sense the pain-free nature of the movement and your brain turns down the pain response.
If a joint is just too painful, then reducing the pain with a steroid injection can give a window of opportunity in which to get things moving better, so that when the steroid wears off, some benefit remains.
Once improved, insoles and exercises can help sustain the improvement to keep you active. If you think this approach might help you, give us a call.
Post Script:
If you are still wondering if pain is really all in the brain, here’s a great talk to further convince you….
