Vana Mana's condition could stem from a number of mental and physical stressors. Circus elephants are forced to assume abnormal positions - standing on tiny stools, for example - for extended periods of time, which place excess pressure on the joints and alters the structure of the elephants' feet.
If an elephant is forced to repeat unnatural tricks, his or her trunk can also suffer damage. In fact, even tricks as simple as shaking the head back and forth can contribute to trunk paralysis - one of Vana Mana's afflictions.
Many circus elephants are also extraordinarily anxious. Circus elephants often exhibit "head bobbing," a common sign of mental distress, Dr. Lori Marino, executive director of the Kimmela Center for Animal Advocacy, previously told The Dodo.
"From the level of sound and commotion surrounding the elephants on display, it would not be too much of an overstatement to say they are losing their minds," she said.
And if an elephant is forced to perform for years with no reprieve, that damage becomes all the more severe.