Frequently Asked Questions

I have type 2 diabetes and a long list of problems caused by this condition. Last fall, I developed a frozen shoulder. They say it's from my heart condition compounded by my diabetes. Now my right ankle is starting to act up. What can I do to prevent a frozen ankle?

Having diabetes heads the list of potential risk factors for joints "freezing up", especially the shoulder. In fact, up to 40 per cent of adults with Type 1 diabetes and 10 to 36 per cent of folks with Type 2 diabetes develop adhesive capsulitis of the shoulder. Adhesive capsulitis is the medical term for this condition. Being a woman or an older adult (40 to 60 years old) also increases the risk of adhesive capsulitis. Injury or trauma to the affected joint may be the cause of secondary adhesive capsulitis. Treatment is based on whether the patient is in the early, mid, or late stage of the condition. Physical therapy is a key feature of treatment in all stages of adhesive capsulitis but especially when the condition is just developing. The physical therapist mobilizes the ankle joint. Mobilization is a hands-on technique. The therapist moves (slides and glides) the joint surfaces in different directions to lubricate and stretch the joint capsule and move the joint. In the early stages of acute adhesive capsulitis, joint mobilization may help decrease inflammation and prevent the formation of fibrous adhesions. You may be given an antiinflammatory medication or steroid injections. The therapist will encourage you to keep moving the joint in order to maintain full joint range-of-motion. Failure to respond to conservative (nonoperative) care may mean surgery. The surgeon inserts an arthroscope into the joint to see what's going on and to correct the problem. This may mean removing loose fragments of bone or cartilage from inside the joint. This type of procedure is called arthroscopic debridement. Prevention is definitely the key to avoiding joint problems. If you haven't already seen an orthopedic surgeon, it would be a good idea to get a difinitive examination and diagnosis. If there are no fractures, infection, or loose fragments inside the joint, then you may be an immediate candidate for physical therapy. The joint may still progress through all three phases (the painful, "freezing" phase, the stiffening phase, and the "thawing") recovery phase. But with a good home program, you should be able to complete the process with minimal discomfort and maximum outcomes (motion, strength, function).

Bilal Shamsi, BS, et al. Clinical Review of Adhesive Capsulitis of the Ankle: An Introductory Article and Clinical Review. In The Foot and Ankle Online Journal. October 2011. E article. Vol. 4. No. 10.

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