Manualtherapy & Myotherapy Works

2 months back one patient came to our department with severe pain , swelling and restricted ankle movements. He is unable to walk without support. He is a lecturer and medically diagnosed with psoriatic arthritis. Disease started 2 years back and his ankle problem started one year back. All other joints are normal. ROM of his both ankle joint is nearly zero.
Most of the ortho specialists advised arthrodesis (surgical fusion of the joint). But he went for a second opinion and consulted with a physician and he directed him to our department for physiotherapy.

We started with hotpacks, then we slowly started mobilization of the joint in classic way. But it was very painful to him. So we applied Mulligan's movement with mobilization for 10mts, followed by myotherapy, deep friction technique over the ankle joint, Ultra sound therapy to reduce swelling. After 2 session we got dramatic result. On second day he has got 25% movement of his ankle joint and swelling reduced to 50%. We continued the same treatment plan and applied crepe bandage after treatment. After 10 days there is 90% reduction in the frequency of pain, swelling disappered and ROM become near normal. He is able to walk without support but mild limping was present... Then we strated some conditioning exercises for leg muscles first with very minimal resistance and progressed with moderate resistace, by the time we continued the mobilization and myotherapy for 10 more days. 

Now he is able to walk without support, gait near normal and ankle movemts are 100%!!
Mobilizations , myotherapy and exercises worked in this condition....