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  Case Study: Life Returns to the Left Ankle  
   Maureen McHugh, Feldenkrais Practitioner                                           703-751-2111

Life Returns to the Left Ankle
by Maureen McHugh

28 October 2005

When I met Vivian G. in June of 2004, I saw a woman in her mid-forties who is tall, beautiful, and naturally vigorous and athletic. But there was something getting in the way of her walk, and I could see it was her left ankle. There was no movement there. 

Vivian and I met at my Summer 2004 Introductory class, which she had heard about through her massage therapist, Barbara Jazzo. Barbara’s massage school had included exposure to the Feldenkrais Method, so she knew that sometimes it can do amazing things. During the Intro class, it was hard for Vivian to do everything that other people can do, and I could see that she was frustrated.

A few weeks later, Vivian came for a private session. She wanted help for the left ankle and also for the rest of her that ached from compensating for the ankle. She reported that she was in chronic pain, although it was currently better than it had been. A year ago it was so bad she thought she would go crazy. Subsequently, she received acupuncture and went through a course of chelation to remove heavy metals. Both had contributed to a reduction in the pain.

Vivian’s ankle trouble had begun when she was 16 and had a serious car accident. She injured the ankle again in an accident when she was 33, and in another when she was in her early forties, in 2002. In each accident, there was trauma to the left ankle. After the third accident, she effectively lost the ability to flex the ankle: it was stuck in a position half-way like a ballerina pointing her toes. Vivian could not walk barefoot without a noticeable limp. Outdoors she had to wear shoes with a heel, and at home, slippers with a heel. Even so, she could only walk for 5 minutes before intensive pain set in, including pain induced by shin splints, and out-of-alignment hips and knees, as well as direct ankle pain. She had to give up all forms of exercise, when hitherto she had been exercising 6 days a week, and happiest when in her Tae Kwan Do class. Although she had cut out exercising at the gym, she still had to walk regularly because she had a dog. In the last couple years, though, she had been relying increasingly on the help of a professional dog walker.

Over the years Vivian had consulted numerous doctors, and they had taken x-rays. The doctors said the x-rays showed gross bone spurs all around the ankle, and no cartilage left in the joint. They said the ankle had been effectively “destroyed.” The only relief for her pain they could offer was surgery. This would take the form either of a fusion, an artificial ankle replacement, or a cadaver transplant. And even these they said had risks, especially in the long term. In coming to Feldenkrais, Vivian was looking for an alternative to surgery.

To deal with the pain, Vivian was taking pain killers most days of the week.

  

When I looked at the left ankle, it was very swollen, easily 50% bigger than the right. On touching the ankle, I could feel that the bones had enlarged. When I asked Vivian to move her foot up and down at the ankle (flexion and extension of the ankle), she could not. Besides the ankle, the rest of the leg was affected: the left leg from the knee down was nearly rigid with no evidence of blood circulation.

I began with Vivian lying on her right side, so that I could gently manipulate her left foot. I began with micro-movements. In the Feldenkrais world we are used to doing small, subtle movements, but, even for us, these were small. I was thinking about circulation and the ability of the foot and leg to respond to the external environment. I would push on a toe and see if it could “go away and come back.” The underlying idea is that each body part has a) its natural shape and b) the ability to move in response to a pressure from the outside world and then c) return to its natural shape. When I began, there was no “responding.” The whole foot was as though dead. Naturally, I kept this observation to myself.

I persevered in working with the foot. Very gradually, over the course of half an hour, some of the toes started to come into this “go away and come back” response. Then I left the foot and gave some attention to the other parts of the body that hurt. At the end of the session, Vivian said the whole area around the left ankle felt “more open” and she happily wiggled her toes.

 

We didn’t see each other next until 3 weeks later because of travel schedules. Vivian reported that for several days afterwards, she had sustained a sense of improvement -- a feeling of more circulation in the left foot and more comfort overall in walking.

 

Over the next 10 months, Vivian came for weekly or bi-weekly sessions. Each time I worked on two aspects of improvement: continuing to soften all around the left ankle and increasing limberness in the rest of her. Each session brought another increment in the range of motion in the ankle and a reduction in the pain and swelling.

For the first two or three sessions, I focused on the “periphery” of the ankle – the toes and the calf muscles, all the parts that were not directly injured but had been drawn into the circle of pain. As these opened up, I moved closer to the central problem. Since the doctors had said that there was no cartilage left in the joint, I was expecting that when I asked for movement in the ankle itself, Vivian would scream in pain. When I finally got to that point, she did not!

I moved the ankle, cautiously, and said, “Vivian, does this hurt?”

She said, with a little exasperation, “No. Why are you asking?”

I said, “Because this is the true movement in the joint. If there is no cartilage there, it should hurt. Since it doesn’t hurt, there must be some cartilage left.”

Each session there was something very touching about the ankle gradually coming back to life. It was as though everybody had given up on it, but inside – it was still alive!

Vivian was able to return to working out at the gym a few times a week. She was also able to gradually reduce the pain medication, and sometimes – to her surprise – she didn’t even need it after stressing the ankle through walking or exercise. She was able to take the dog on 20 minutes walk a couple times a day, without difficulty. One evening in November she went to a night club and stood for 2 hours, whooping and hollering with everyone else, and was not sidelined by ankle pain.

One Saturday morning in December, though, she went Christmas shopping and walked for five hours. When she came to our afternoon session, the ankle was sore and swollen again, and she was in pain. I worked following a similar pattern as in previous sessions, and the swelling and the pain subsided greatly in 50 minutes. When she sat up at the end of the session and looked at her much more normal-looking ankle, she looked up at me and said, “How do you do that?”

In subsequent weeks, Vivian continued gradual improvement. She became more able to flex and extend the ankle on her own (active movement rather than passive), and the rest of her became more “wiggly” and “cat-like,” which she loved. She even began to be able to stand barefoot and take weight on the left heel, at first only very briefly and with the legs wide apart (like ballet second position); and then gradually for longer and with the legs closer together. The hip pain mostly went away, and she was able to give up a pain-induced, stiff way of holding herself and re-learned how to walk more fluidly. She tells me that she consistently feels now a sense of liveliness in the ankle. She is continuing at home with her Feldenkrais movements, and hopes that the benefits will continue to accumulate.

Vivian took a break from our regular sessions at the beginning of June 2005. Then she came back for a few refreshers in August. Currently, at the end of October 2005, she is doing other things on her Saturday afternoon! The ankle is holding its own, and holding her.

 

Author’s note: 10/26/05. I sent this as a draft to Vivian for review. She made some corrections and returned the story with this postscript:

 “I’ve made a few edits…..I don’t want it to sound like I got the old/original ankle back….I still have limited flexion for sure! But I do want to celebrate the difference!   
It is an amazing story, thank you for helping to make the story come true. 
I just got in from a 20-minute walk with the dog!  HA!
Vivian”

 

Author’s note: 3/26/06. Vivian surprised me today with this email update:

Hi Maureen, 

I am just back from a walk with my dog, and I wanted to tell you that my ankle is doing well.  I am walking further these days, and I remember to be "Mr. Wiggly" and move my whole body, including the back and shoulders and head and neck, when I walk.  I am doing the stretching exercise and find it to be very refreshing and rejuvenating.  The ankle is still "eccentric" but there has been sustained improvement and I wanted to let you know the good news. 

Vivian