“My ankle hurts... is surgery really the answer?”
Recently, a patient complained of ankle pain and plantar fasciitis symptoms after undergoing uterine surgery.
- On MRI, there was a micro-defect in the cartilage, so Western medicine recommended surgery
- The patient's ankle joint felt stiff and painful in the morning, but was not significantly uncomfortable during exercise or activity
- A situation where the patient was worried and contemplating surgery
However, upon examination during Korean medicine treatment, it turned out to be not just a problem with the ankle itself, but
- Weakening of the Achilles tendon
- Tension in the calf muscles
- Issues with the popliteus muscle (muscle behind the knee)
- Leg edema resulting from inguinal lymphatic circulation impairment after uterine surgery were intricately intertwined.
- During that day's treatment, simply releasing the inguinal lymph with massage reduced the leg edema, and it was impressive that the ankle pain was also significantly relieved.
1) Western Medical Diagnosis: Focusing on Local Structures
MRI, Ultrasound, X-ray
- In Western medicine, MRI is used to accurately determine whether there is a cartilage defect or ligament tear.
- Example: If a cartilage abnormality of 8 mm or more is found, surgery (such as microfracture, cartilage transplantation, etc.) is sometimes recommended.
- For plantar fasciitis or Achilles tendon issues, ultrasound Doppler and other modalities are also used to identify local inflammation or micro-tears.
Inflammation and Mechanical Stress
- “Morning pain” is viewed as the result of the action of local inflammatory mediators (IL-1, TNF-α, etc.) and accumulated mechanical load, and an attempt is made to resolve that area through surgery, physical therapy, injections, and the like.
- In other words, the focus is on ‘repairing’ the damaged area of the cartilage and ligaments.
In this way, Western medicine is a method of finding a solution by analyzing the chemicals (cartilage damage, etc.) at one point in the river (the ankle).
It is characterized by a reductionist approach that thoroughly identifies the local lesion and corrects the problem area through ‘surgery’ or suppresses inflammation.
2) Korean Medicine Diagnosis: Surveying Whole-Body Circulation and Meridian Flow
Post-Uterine Surgery Lymphatic Circulation Disorder, Lower Extremity Edema
- Korean medicine does not view ankle pain merely as “cartilage damage,” but examines the overall disharmony of the five viscera and six bowels (internal organs), meridians, and lymphatic function.
- In this actual patient, a chain of issues was observed following pelvic surgery, where impaired inguinal lymphatic function → edema in the calves and popliteal area (behind the knees) → led to weakening of the Achilles tendon.
- It is interpreted that when dampness-phlegm accumulates in the legs, the circulation of qi and blood becomes blocked, meridian function declines, and pain develops in the joint (ankle).
- Relieving the inguinal lymph by hand and relaxing the calf fascia improved the ankle pain as well—this is an example where Korean medicine's “arranging the entire flow” alleviated a local problem.
This approach is similar to a macroscopic perspective that looks at the flow of the entire river, aims to block pollution sources upstream, and even seeks to purify it.
3) Differences in Diagnostic Paradigms: The “River Water Pollution Metaphor”
- Western medicine: “The river water is contaminated → Analyze which specific chemical substance is the problem → Administer agents to remove only that substance.”
- Ankle: “Identify cartilage damage with an MRI → Localized solutions such as surgery and injections.”
- Korean medicine: “Look at the entire river like a map, comprehensively grasp where the contamination entered from and what the river flow is like → Block the cause (source of pollution) & purify the river.”
- Ankle: “A chain reaction such as uterine surgery → pelvic lymphatic disorder → calf edema → ankle pain.”
In the end, this shows the difference in diagnostic philosophy: Western medicine focuses on localized lesions, whereas Korean medicine focuses on whole-body circulation (lymph, meridians, fascia, etc.).
4) “Ankle pain: why is viewing the whole body important?”
- Lymphedema increases the burden on ankle cartilage
- Leg swelling reduces the calf muscle pump function, increasing intra-articular pressure in the ankle.
- Chronic increase in internal pressure accelerates cartilage wear
2. Tension in the Achilles tendon and popliteus muscle affects ankle angle (ROM)
- When moving the ankle, the calf-ankle muscles and ligaments work together.
- If a problem occurs behind the knee or in the calf, it is easy to recur even if “only the ankle” is corrected.
3. Blockage of meridians in the pelvis and legs after abdominal surgery such as uterine surgery
- Korean medicine perspective: When pelvis → lower extremity circulation is interrupted, the ankle develops chronic symptoms such as “stiff pain every morning.”
5) Western medicine and Korean medicine diagnosis: it is more accurate when viewed together
- Western medicine: Precisely analyze the condition of ligaments and cartilage with MRI and ultrasound → Accurately identify whether localized damage exists.
- Korean medicine: Check for “post-surgical lymphatic and meridian disorders” or “whole-body dampness-phlegm and edema” → Identify sequential problems in muscles and ligaments.
If a patient looks only at the ankle MRI and concludes, “Cartilage abnormality → I need surgery,”
there is a high possibility that pain will recur because lymphedema or fascial issues are not resolved even after surgery.
Therefore, it is more desirable to consider both perspectives, localized and systemic.
Conclusion: “If your ankle hurts, let’s not look only at the ankle.”
- While localized structures (cartilage, ligaments, MRI results) are certainly important,
- One must also examine overall circulation (lymph, muscles, meridians, aftereffects of abdominal surgery) to identify the true cause.
- Patient case: Uterine surgery → inguinal lymph issue → leg edema → calf fascial stiffness → ankle pain
- Symptom relief through improving circulation (lymphatic massage, fascial release) instead of surgery
- Many cases can improve without surgery when using an integrative approach
“If you are wondering, ‘Do I really need ankle surgery?’
We recommend that you also examine whether there are issues with the whole body's flow (lymph, fascia, meridians)
from a Korean medicine perspective.”
