Treatment of Bilateral Pitting Edema of the Ankles
The patient was a 54-year-old female diagnosed with bilateral pitting edema of the ankles. Initial onset of edema in her ankles occurred in late 2009. Before a low back injury in 2008, the patient’s BMI was roughly 29.3. The low back injury left the patient bed ridden for two months. Because of the lack of exercise and improper diet, she presented to my office with a measured BMI of 45.7. Because of the patient’s condition, she had difficulty walking for more than 5 minutes and was walking with two forearm crutches. The patient also reported insidious onset of knee pain a year prior. She had received previous physical therapy, which included stretching exercises and ultrasound, as well as six treatments with acupuncture to help with the edema in her ankles. Treatment provided little or no relief.
Physical Examination
Upon examination, the patient measured 5-feet-2 and weighed 252 pounds. The patient walked in an antalgic gait. Without crutches, the patient exhibited a waddling gait with no apparent bend of her knees. Lower extremity examination revealed loss of muscular tone in the hamstrings and gastroc/soleus bilaterally with an overdevelopment of the quads. Measured ROM of flexion of the knee was 55 degrees on the right and 70 degrees on the left. Passive ROM went to 64 degrees on the right and 79 degrees on the left with a hard capsular end feel bilaterally. Ankle ROM was within normal limits. Orthopedic testing was performed on the knees and revealed a presence of meniscus injury. Pitting edema was noted bilaterally with a grade of 3+, with no signs of redness or pain upon palpation. Evaluation with GT instruments GT2, revealed moderate soft tissue restriction throughout knee flexors and knee extensors bilaterally. GT3 was used to evaluate the ankles, and it was noted when passing the instrument over the medial and lateral malleolus large amounts of fluid was pushed out with each pass. After seeing the results through the evaluation, it was then determined to use GT3 for instrument-assisted edema reduction.
Upon examination, the patient measured 5-feet-2 and weighed 252 pounds. The patient walked in an antalgic gait. Without crutches, the patient exhibited a waddling gait with no apparent bend of her knees. Lower extremity examination revealed loss of muscular tone in the hamstrings and gastroc/soleus bilaterally with an overdevelopment of the quads. Measured ROM of flexion of the knee was 55 degrees on the right and 70 degrees on the left. Passive ROM went to 64 degrees on the right and 79 degrees on the left with a hard capsular end feel bilaterally. Ankle ROM was within normal limits. Orthopedic testing was performed on the knees and revealed a presence of meniscus injury. Pitting edema was noted bilaterally with a grade of 3+, with no signs of redness or pain upon palpation. Evaluation with GT instruments GT2, revealed moderate soft tissue restriction throughout knee flexors and knee extensors bilaterally. GT3 was used to evaluate the ankles, and it was noted when passing the instrument over the medial and lateral malleolus large amounts of fluid was pushed out with each pass. After seeing the results through the evaluation, it was then determined to use GT3 for instrument-assisted edema reduction.
Treatment
Initial treatment consisted of GT3 to the ankles bilaterally. Instrument-assisted edema reduction was performed with the patient in the prone position and knees bent at end range. GT3 was used with deep slow strokes pushing the fluid cephalically. GT was performed bilaterally to both ankles for a total of 10 minutes. Post-GT treatment edema rating went from a 3+ to a 1+ in a matter of 10 minutes. The patient was instructed on Thera-Band exercises for resisted knee extension and flexion as well as ankle dorsiflexion and plantar flexion. Patient was instructed to elevate her feet at home post-GT.
Initial treatment consisted of GT3 to the ankles bilaterally. Instrument-assisted edema reduction was performed with the patient in the prone position and knees bent at end range. GT3 was used with deep slow strokes pushing the fluid cephalically. GT was performed bilaterally to both ankles for a total of 10 minutes. Post-GT treatment edema rating went from a 3+ to a 1+ in a matter of 10 minutes. The patient was instructed on Thera-Band exercises for resisted knee extension and flexion as well as ankle dorsiflexion and plantar flexion. Patient was instructed to elevate her feet at home post-GT.
Discussion
This patient exhibited an excellent response to treatment in a short amount of time. Because of the patient’s age and other health issues, the patient will have to make some serious lifestyle changes in order to become pain-free. The dysfunction in her ankles appeared to be caused by lack of natural muscular tone and restriction in the muscular and fascial components
of her lower extremities. With further care and constant health advice, this patient can improve significantly over time.
This patient exhibited an excellent response to treatment in a short amount of time. Because of the patient’s age and other health issues, the patient will have to make some serious lifestyle changes in order to become pain-free. The dysfunction in her ankles appeared to be caused by lack of natural muscular tone and restriction in the muscular and fascial components
of her lower extremities. With further care and constant health advice, this patient can improve significantly over time.
By Karson Mui, DC, Mui Chiropractic and Wellness Center, West Newton, MA
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