Osteopathy and the Ankle: Between Biomechanics and Myths
Ankle pain, particularly aftermath of sprains and tendinopathies, is a frequent reason for consultation. While osteopathy is a solution of choice for restoring mobility and preventing recurrence, it is essential to distinguish evidence-based manipulations from unfounded theories.
Understanding the Ankle: A Stability Complex
The ankle is not an isolated joint; it is the crossroads between the leg and the foot, involving the tibia, fibula, and talus (astragalus).
Ankle Sprain: This is a ligamentous injury. Osteopathy intervenes to restore joint mobility once the acute inflammatory phase has passed.
Proprioception: This is the brain's ability to stabilize the ankle. Manipulations help "wake up" the joint's nerve sensors.
Ascending Chains: A blocked ankle can alter gait and create pain in the knee, hip, or even the lower back.
Critical Analysis: Osteopathy Myths
Some traditional explanations lack scientific rigor and can mask clinical reality.
A. The "Somato-Emotional" Osteopathy Myth
The Belief: Recurring sprains are supposedly a sign of difficulty "moving forward in life" or emotional indecision. People often speak of "tissue memory" that stores psychological trauma.
The Critical Reality: While it is true that stress influences muscle tension, there is no scientific evidence that a specific emotion causes a sprain. Recurrence is generally due to poor proprioceptive rehabilitation or mechanical instability, not an unresolved psychological conflict. Focusing on the emotional aspect risks neglecting indispensable physical strengthening.
B. The "Displaced" Bone Myth (The "out" Talus)
The Belief: The osteopath tells you that your astragalus (talus) is "out" toward the front and that they must "put it back in place."
The Reality: Except for traumatic dislocation, a bone does not displace. What is felt is a restriction of mobility. Manipulation releases the joint and decreases surrounding muscle tension through a neurological reflex.
C. The Visceral Osteopathy Myth
The Reality: There is no evidence that manipulation of the liver or colon can treat an ankle pathology. The ankle is a mechanical support joint; its treatment must remain mechanical.
Scientific Reality: What Really Works
Osteopathy is effective when it relies on neuromechanics.
Chronic Pain Reduction: Meta-analyses (e.g., Franke et al.) confirm that osteopathy significantly reduces pain with an effect size of 0.60.
Improvement of Post-Traumatic Mobility: After a sprain, mobilization of the bi-malleolar mortise (tibia-fibula) is crucial to regain a normal gait.
Recurrence Prevention: Combined with exercises, osteopathy reduces the sprain recurrence rate from 28% to 12%.
Multidisciplinary Management
Osteopathy is a key step in rehabilitation, but it is not sufficient on its own.
Diagnosis First: In case of impact, an X-ray is often necessary to rule out a fracture before any manipulation.
Movement Next: Osteopathy "unblocks," but it is strengthening that stabilizes.
Honesty: A good practitioner will treat your ankle and leg but will not claim to heal your ligaments by analyzing your emotions or massaging your stomach.