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MR R (narrative reasoning (previous Hx, ankle sprain (scar on ATFL…
MR R
narrative reasoning
pain at right ankle started a few weeks ago, happens whenever he uses a ladder, initially started in 2016--> more plantarflexion while using ladder require more strength art calf mm and more range at the ankle
usually ladder flare up and getting tight at the medial and lateral malleolus--> tendon tight, posterior tibialis tendon, peroneous longus and brevis tendon
nil P&N, N nil neural sign
feels like ankle is very loose and unstable to walk on, could be tendon or ligament problem
no clicking feel, but blocks by swelling
agg, walking, stairs which requires ankle plantarflexion
ease, ice massage, pain killer--> mechanical injury
24/24, pain at night and difficult to fall asleep, tight at morning, pain getting worse after day--> tendinopathy inflammatory injury, mechanical injury
previous Hx, ankle sprain
scar on ATFL ligament, reduce the movement of talus joint
GH is good, no regular medications, no previous surgery
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dialogiusm
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like soccer and eager to back to play soccer, felt the taping is annoying while walking b/c too tight
explain to him that the taping is good for swelling and make ankle stable as a crunch, and it is unsafe to plat competitive soccer
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evidence based practice
tightness at the calf mm-->release calf and poreneals, work a little
imaging shows the ATFL has scar, posterior tibialis tendinopathy issue, do PAIVM at talus joint, pain improves a lot
education: not agg the tendon pain due to more plantarflexion, like plaing soccer
talk with surgeon about the condition and listen to their suggestion
PT supervisor, why cannot do isometric hold for reducing pain--> no muscle talus
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pattern recognition, chronic pain, tightness in the morning, previous lateral ankle sprain, --> tendinopathy?