Fibula Stuck in Superior Glide: A Rare Injury
This is an unusual and rare injury with a fabulous outcome. I treated my son Gabriel once and shortly thereafter, he was pain free and went on to resume training and 2 months later, won first place in his age group and 9th overall (see link below) in a grueling hill race, the Albuquerque La LUz Run (see 2nd link below). This run was honored as one of the "12 Most Grueling Trail Races in North America" by the fall 2001 issue of Trail Runner Magazine.
http://www.laluztrailrun.org/2008/La_Luz_Final_Results_2008.pdf,
http://www.laluztrailrun.org/.
I am delighted to begin reporting this case study as it involves my son Gabriel Hesch a 24 year old teacher in Albuquerque, New Mexico. He came to visit me in June 2008 and he was having some pain in the area of the superior tibiofibular joint and diffuse foot pain. I noted swelling along the lateral compartment of the lower leg which concerned me. I was fatigued that evening so deferred detailed evaluation and treatment until the following day. He did not have a limp, in fact there was no noticeable gait deviation, however, the eval revealed that he could not hop on that leg due to pain. He also had inhibition of all foot and ankle muscle groups, and reduced unilateral stance balance. The following morning (prior to treatment) he did have reduced swelling and improved muscle function except that his evertors were still inhibited. The improvement was most likely due to rest and reduced swelling from recumbent sleep position.
http://www.laluztrailrun.org/2008/La_Luz_Final_Results_2008.pdf,
http://www.laluztrailrun.org/.
I am delighted to begin reporting this case study as it involves my son Gabriel Hesch a 24 year old teacher in Albuquerque, New Mexico. He came to visit me in June 2008 and he was having some pain in the area of the superior tibiofibular joint and diffuse foot pain. I noted swelling along the lateral compartment of the lower leg which concerned me. I was fatigued that evening so deferred detailed evaluation and treatment until the following day. He did not have a limp, in fact there was no noticeable gait deviation, however, the eval revealed that he could not hop on that leg due to pain. He also had inhibition of all foot and ankle muscle groups, and reduced unilateral stance balance. The following morning (prior to treatment) he did have reduced swelling and improved muscle function except that his evertors were still inhibited. The improvement was most likely due to rest and reduced swelling from recumbent sleep position.
Basic Concepts of a Fibula Stuck in Superior Glide
1. This is a rare and unusual injury and there is very little in the literature to describe it.
2. It is basically the opposite of the typical ankle inversion injury, it is a superior glide fixation of the fibula.
3. The injury causes pain because the fibula loses superior and inferior motion and thus the foot and ankle becomes less effective as a shock attenuator and soft tissue pain ensues.
4. The palpatory findings are rather subtle and thus it can be overlooked. There is not much physiological superior glide of the fibula and it seems to be enhanced with abduction and eversion (in dorsiflexion) of the foot and ankle. I cannot perceive any superior glide of my fibula with pure dorsiflexion. Some authors report that superior glide is actually enhanced with adduction of the foot, and I would implicate anatomical variance in the shape of the superior and inferior tibiofibular joints, which has been reported in the literature.
5. The injury seems to be an overuse injury and perhaps due to a large passive force imparted when the foot and ankle are in abduction and eversion (and dorsiflexion) and hill running is perfect for imposing these kinds of motions and forces.
6. Palpation of the fibular head and lateral malleolus will reveal ligamentous tension which is greater than the opposite side. the same is true with regards to the soft tissue especially the tibialis anterior and the peroneal group (now named fibularis).
7. Passive superior and inferior glide applied to the lateral malleolus and fibular head will be blocked. Anterior and posterior glide at both ends of the fibula will be variable; either hypermobile or hypomobile, based on anatomical variation.
8. Treatment is very easy, very straightforward. It involves placin the foot and ankle in maximum inversion (because this is non weight-bearing, you will not cause an inversion ankle sprain). The therapist make purchase on lateral malleolus and the fibular head and tractions the fibula inferiorly with moderate force for 2-3 minutes.
9. Again because the great majority of ankle injuries are inversion injuries and this is essentially the opposite, it is probably overlooked in the patient population. research in the non-responders may reveal a higher incidence of this type of injury I am still researching the literature and intend to fully describe my findings and treatment and provide a video link to show the most relevant part of the evaluation and treatment.
2. It is basically the opposite of the typical ankle inversion injury, it is a superior glide fixation of the fibula.
3. The injury causes pain because the fibula loses superior and inferior motion and thus the foot and ankle becomes less effective as a shock attenuator and soft tissue pain ensues.
4. The palpatory findings are rather subtle and thus it can be overlooked. There is not much physiological superior glide of the fibula and it seems to be enhanced with abduction and eversion (in dorsiflexion) of the foot and ankle. I cannot perceive any superior glide of my fibula with pure dorsiflexion. Some authors report that superior glide is actually enhanced with adduction of the foot, and I would implicate anatomical variance in the shape of the superior and inferior tibiofibular joints, which has been reported in the literature.
5. The injury seems to be an overuse injury and perhaps due to a large passive force imparted when the foot and ankle are in abduction and eversion (and dorsiflexion) and hill running is perfect for imposing these kinds of motions and forces.
6. Palpation of the fibular head and lateral malleolus will reveal ligamentous tension which is greater than the opposite side. the same is true with regards to the soft tissue especially the tibialis anterior and the peroneal group (now named fibularis).
7. Passive superior and inferior glide applied to the lateral malleolus and fibular head will be blocked. Anterior and posterior glide at both ends of the fibula will be variable; either hypermobile or hypomobile, based on anatomical variation.
8. Treatment is very easy, very straightforward. It involves placin the foot and ankle in maximum inversion (because this is non weight-bearing, you will not cause an inversion ankle sprain). The therapist make purchase on lateral malleolus and the fibular head and tractions the fibula inferiorly with moderate force for 2-3 minutes.
9. Again because the great majority of ankle injuries are inversion injuries and this is essentially the opposite, it is probably overlooked in the patient population. research in the non-responders may reveal a higher incidence of this type of injury I am still researching the literature and intend to fully describe my findings and treatment and provide a video link to show the most relevant part of the evaluation and treatment.