Ankle collapsing inwards when walking

Tagged: Ankle turning in due to weakness

Viewing 6 posts - 1 through 6 (of 6 total)

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Jellyhall
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April 19, 2019 at 1:00 pm

Post count: 91

#30379

Dr corenman,

I have problems throughout my spine, but we are focussed on trying to relieve my lumbar spine pain at the moment.
I had a lumber fusion and decompression of L4/5 for spondylolisthesis 9 years ago. Sadly, the two levels above (L3/4 and L2/3), and one level below (L5/S1) are in a bad way now with atrophied facet joints, herniated discs and spinal stenosis.

A pain that I have had in the past, but only occassionally, is a feeling that I have very badly sprained my left ankle meaning that I find it very painful to try to walk on it. The pain is at the inneer ankle and upwards to about mid calf, again on the inner part. Previously while walking I would experience this pain, causing me to limp and sometimes have the feeling that my ankle is giving way. It would last for a while, but as I continued to walk by limping it would slowly resolve and be gone.

This pain has deteriorated and I have experienced this pain in the inner ankles more often now, but it is lasting much longer and gets worse and worse as I try to walk. I have found that if I sit down for a while it improves, but it will return if I keep walking again.

Today, because I have shorter trousers and no socks on I have noticed that my foot is taking up a strange position as I put weight on that foot. I am flat footed anyway, but now this foot/ankle is collapsing inwards and turning out slightly. Especially as my body moves forwards over the foot this is very noticeable. It doesn’t happen with the other foot, other than being flat footed.

I am wondering if this is being caused by weaker muscles in my ankle and inner calf. Could this be coming from my lumbar spine problems?

I am hoping that physiotherapy will be able to strengthen my ankle again so that I can walk normally.

Donald Corenman, MD, DC
Moderator

April 19, 2019 at 7:42 pm

Post count: 8660

#30382

Your complaint of; “feeling that I have very badly sprained my left ankle, pain is at the inneer ankle and upwards to about mid calf, sometimes have the feeling that my ankle is giving way
and now this foot/ankle is collapsing inwards and turning out slightly”. The L5 nerve could be affected. This nerve serves the Extensor Hallicus Longus muscle (brings up the great toe), the peroneal muscles (brings the foot out to prevent spraining the ankle) and about 50% of the time. tibialis anterior (foot drop). If your L5_s1 level has been affected by the degeneration, you might have foraminal stenosis which could compress the L5 nerve.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Jellyhall
Participant

April 20, 2019 at 12:02 pm

Post count: 91

#30383

Thank you Dr Corenman, for your reply.

On reading my message to you I have noticed some errors.
I meant to say that I have … hypertrophied facet joints …

and that … this foot/ankle is collapsing inwards and my foot is turning out slightly.

I will be having a left facet joint injection at L5/S1 in 8 days. Do you think that it may help this pain and weakness?

Donald Corenman, MD, DC
Moderator

April 21, 2019 at 12:13 pm

Post count: 8660

#30385

I assumed hypertrophied facets as this is what occurs with degeneration. The foot collapsing inwards is typical for peroneal weakness which can originate from an L5 radiculopathy. If you have radiculopathy (leg pain with motor weakness), the facet block is the wrong injection. In the face of radiculopathy, I would consider a selective nerve root block.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Jellyhall
Participant

April 26, 2019 at 12:02 pm

Post count: 91

#30400

I think that the reason they want to begin with facet joint injections is because they did a SPECT CT scan, and although I have many levels with increased uptake of the radioactive substance, the left facet joint at L3/4 and L5/S1 are glowing particularly intensely.
They have suggested that we try a caudal epidural injection next, which they say will be able to flood up to cover three levels of L5/S1, L4/5 and L3/4. Do you think this is a sensible idea that would help me?

Donald Corenman, MD, DC
Moderator

April 29, 2019 at 4:55 am

Post count: 8660

#30403

Caudal epidurals are an old technique that can work well but are not diagnostic. This injection takes a significant amount of fluid mass to get up high enough and sometimes doesn’t not reach its intended target. None-the-less, it is an acceptable technique. I still would recommend a more specific injection to can hone in on the area of suspicion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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