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Old 12-03-2008, 05:49 PM   #1
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"Sprained Ankle"

On October 3rd, I was working in my garage and fell (all of two feet) off of the step ladder. I felt a pop and my left ankle immediately swelled up. The pain was severe and I could not put any weight on it.

The next day I went to the emergency room and the x-ray showed no break / fracture and I was told I had a severe ankle sprain and was sent home with a wrap, crutches and pain meds. It was a week and half before I could stop using the crutches. The swelling and bruising remained. After 4 weeks I went to my GP because it did not seem to be getting any better. He referred me to an ankle specialist. The specialist examined and manipulated my ankle (which hurt a lot). Based on this and the continued pain and swelling, he ordered an MRI.

The MRI revealed the following:

Grade 3 and Grade 2 ligament sprains.
Longitudinal split of the Peroneal brevis tendon
Fracture of the medial talar neck and head. (non-displaced)
Non articualr medial talar cortical fracture (non-displaced)
Numerous “bone contusions”

My doctor put me in a non weight bearing splint/boot and told me that I need to stay off of my ankle (crutches) for 5-6 weeks. ( I had been walking on this foot for several weeks!)

He scheduled a follow up at 3 weeks. He stated that he prefers to try non-surgical options before surgery but from his demeanor, I get the feeling that he knew that at some point surgery may be required to address some of these issues. (When I asked about the upcoming ski season, he said it would be unlikely I would be doing any skiing this year)

Has anyone had a similar experience with multiple problems (Sprain + Talur Fracture+ Tendon Damage)? I think I have three concerns: The Talus fractures, which can be bad, especially if they are displaced – which mine are not, the Peroneal brevis tendon rupture, and the ligament damage.

Any insight / experience would be appreciated.

 
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Old 12-04-2008, 04:56 AM   #2
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Re: "Sprained Ankle"

Unfortunately if you have a torn tendon (verified by an MRI vs. speculation), tendons do not heal themselves and need to be repaired surgically. I tore my posterior tibial tendon (longitudional split tear as well) in a fall and had surgery where they took the tendon to my big toe and grafted it to my posterior tibial tendon. Basically my big toe tendon has taken over the function of the posterior tibial tendon. The snapping you heard might have been the tendon tearing. I might suggest looking into this a bit more, if you really need surgery and the tear is obvious perhaps you could do it sooner rather than later. Good luck.

 
Old 12-04-2008, 12:34 PM   #3
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Re: "Sprained Ankle"

Yeah, a longitudinal tear of a peroneal tendon is unlikely to heal by itself.

Still, the bone injuries should heal if you rest. Maybe it'll be easier to do the surgery if the trauma that will heal on its own has a chance to.

Good luck, and keep us posted. It sounds like you are in the hands of a doctor who really knows his stuff.

 
Old 12-10-2008, 08:43 PM   #4
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Re: "Sprained Ankle" = Fractires Talus, Peroneal Brevis Tendon Rupture,Ligament damag

So..

I met with the ankle surgeon today..

1) Now that the swelling is down he has put me in a cast, instead of the boot. (No more scratching the itches!)

2) Based on my activity level, he says that at some point, I need surgery to repair the split in my peroneal brevis tendon and to address the ligament issues.

3) He is very concerned about the talus fracture and wants to imobilize me for another 3-4 weeks and then assess the situation before he does any surgery. (I get the feeling that this may require some surgical intervention as well.)

I am kind of stressing out because I feel like I have several things going on here and ideally I would like to get them all taken care of - at once. My ski season is already written off. (BTW we do not have a lot of snow up here in WA) I have lowered my expectations and hope to to be back in commission by summer.

Any input and/or comments, and sharing of your experiences would be greatly appreciated...

Ken

 
Old 03-13-2009, 12:29 AM   #5
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Re: "Sprained Ankle"

I have had multiple problems with my ankle, although not the exact same ones you've had. I have completely avulsed 2 of the lateral ankle ligmanets, the ATFL an CFL. I had a double ankle reconstruction and I have permanent sutures that I can still feel. About 2 years later, I sprained the ankle again and felt a pop at the proximal end of the peroneal brevis tendon. I went through therapy. About a year and a half after that, I sprained the same ankle, tore cartilage, and broke the 5th metatarsal! I was diagnosed in the ER as a foot contusion when I actually had a sprained ankle, torn ankle cartilage and a broken foot! A serious break at that. I was told the only way to avoid a cast is if I promised not to put any weight at all on my ankle/foot. Not even a toe on the ground. The problem is that hardly any blood supply gets to that part of the foot so no healing really occurs. I was on crutches for 6 wks and had a bone stimulator and thankfully avoided surgery. I was told, though, that I would need surgery to clean out the torn cartilage and significant scar tissue. I haven't signed up for that yet though.

Now, i still experience a few sprains per year. The swelling and bruising eventually subside, but the pain lingers especially when I run. Hope that helps some!

 
Old 03-13-2009, 05:56 AM   #6
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Re: "Sprained Ankle"

I had just about the same thing for my first surgery. I sprained it in karate, heard the noise of something popping/tearing and did just about the same thing you did. I went to the ER and they put me in an ace bandage and crutches and sent me on my way. I couldn't bear any weight on it so I went the next day to an OS and he told me, "Haven't you ever sprained an ankle before?" There were no broken bones on the x-ray. Well, I had informed him, yes, I had sprained my ankle before, but NEVER LIKE THIS. He blew me off as some wimp and sent me on my way.
I went on to compete 3 weeks later in a karate tournament which I'm sure didn't help, but in my mind I was hearing the dr.'s words of just a sprained ankle.
about 4 weeks after the sprain I went to a much better OS who only does ankles and the foot. He made me to PT and more crutches for awhile. At 3 mos post injury, I had a Brostrom repair for the ligaments, my peroneal brevis was also torn, my peroneals also were subluxing, and I had 2 spots of OCD or also known as talar dome fracture.

The OCD's were drilled and microfractured, the peroneals fixed and the Brostrom -Gould procedure done. I also had scar tissue cleaned out.

I did okay for awhile, and got back to karate and competition. But then about 1.5 yrs post op things started going down hill again. I had my Brostrom redone and an anatomical reconstruction done, my peroneals were torn again (don't ask me how I did that because I never injured it again the same way) and I had a procedure called an OATS procedure for talar dome. Now, the OATS is a very last resort type surgery, so you'll probalby have drilling done first on the spots on your talar dome.

I'm 6 mos out and not doing well. My best advice is don't get back to activity too soon. A bad ankle sprain like you had is a serious injury. I think I got back into contact sports way too soon and that led to my ankle being so messed up. I still blame that stupid dr. I saw first who blew me off as a wimpy middle aged housewife.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 03-13-2009, 08:59 AM   #7
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Re: "Sprained Ankle"

I would agree with Kris. Don't go back to activity too soon after surgery. I did that as well. I went back to working in the ICU for 13 hours a day only 5 wks after surgery and still in the boot. I had complications from that big time. IF I decide to have surgery again on my ankle, which I need, I WON'T go back to any kind of high level activity for a while.

Okay, not subject related, but I can figure out how to reply to a post, but how do I start a new one for a question about my ankle that I have? I can't figure that out for some reason.

Thanks!

 
Old 03-13-2009, 10:33 AM   #8
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Re: "Sprained Ankle"

On the main page under "Foot Problems Message Board" there is a tab for "New Thread".

click on that to start your own thread.

 
Old 03-13-2009, 12:34 PM   #9
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Re: "Sprained Ankle"

Hi Ken,

Ditto to what others say. Stay off your foot definitely and don't try to hurry recovery. Those are serious injuries for sure. The thing Dr.'s worry about when you fracture the talus is AVN or avascular necrosis. That's when the bone loses blood supply and eventually dies. I'm not trying to scare you because your Dr. is really watching it and keeping your foot protected. But don't try to cheat and walk on it when you shouldn't and you'll probably be doing well next summer!

I had a less serious injury and it was also misdignosed as an ankle sprain (like Kris). I ended up having surgery to repair a fractured portion (OCD) that went necrotic. You're very fortunate they've caught it soon!

Abby

 
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