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Old 03-28-2009, 03:41 PM   #1
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Question Sprained Ankle 7 weeks ago

I sprained my right ankle 7 weeks ago when I fell while walking down my basement steps. I got to the last step, stepped down on my basement floor with my right foot, foot went inwards, felt snap and pain, fell down with foot and leg underneath me. I got up, walked around, ankle felt weak and unstable, but pain was minimal at the time. My ankle swelled up and bruised later, and became more painful. I could not walk without a brace or crutches. I even wore the brace at night because I could feel movement in my ankle. Went to the family doctor five days later, and had an xray. Xray came back good. No fractures and no dislocations. Weeks go by - swelling is down but there is pain and limited mobility in my right ankle. My foot looks crooked - the left side is in an upwards position and the right side a downwards position. There is definitely a difference between the left foot and the right foot. I walk with a steppage gait with my right foot because mostly the outside part of my foot hits the ground. I go to orthopedic foot doctor. They send me to physical therapy, and tell me to wean myself off of crutches and brace. I try to do that and my ankle begins to swell and cause me pain just as if I sprained it yesterday. I go back to orthopedic doctor, and I beg for an MRI.

MRI comes back saying I have focal bone marrow edema present involving a small portion of the medial aspect of the body of the talus, which probably represents bone contusion secondary to inversion injury.

AFTL ligament is normal, but enlarged and edematous, representing strain or partial tear. CFL ligament is probably intact, and is normal in course.

Small amt of fluid in peroneal tendon sheath. No peroneal tendon tear, subluxation, or significant tendinopathy demonstrated.

Increased signal present in the deep deltoid ligament region, indicating edema related to the acute injury or intrasubstance degeneration of the deltoid. Deltoid is intact.

No medial tendon tears present. Some signal in Achilles tendon which is common finding on ankle MRI examinations without tendon enlargement or tears.

Small ankle joint effusion. No loose bodies demonstrated. No talar dome osteochondral defects.

What's all this medical jargon mean? Can somebody explain what could cause my ankle to be crooked if there is no dislocations in the ankle joint? Can a muscle, tendon or ligament atrophy and pull my foot into an incorrect position? It's very noticeable - there is a huge difference between the left foot and right foot. I cannot move my foot up and down or side to side. When I do try, my foot goes into a violent spasm.

Last edited by Crooked Ankle; 03-28-2009 at 03:45 PM. Reason: additional information

 
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Old 03-28-2009, 04:51 PM   #2
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Re: Sprained Ankle 7 weeks ago

Crooked Ankle, I wish I had some helpful words for you. I know that my ankle injury happened much like yours although I was stepping off a curb in front of a Dunkin Donuts! My injury lasted SO much longer than anyone suspected and it wasn't until almost a year later we learned that I had done more damage than we initially suspected and finally had surgery this last July.
Don't stop asking your PT and doctor questions! Only you know how your foot feels. I didn't have the issues with the crooked foot, just continued isolated pain and weakness and it took me a long time to get it resolved. Good luck and keep us posted!

 
Old 03-28-2009, 05:21 PM   #3
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Re: Sprained Ankle 7 weeks ago

Hi crooked ankle, Sorry your here. Some of the words you can search and find out the meanings if you dont get help here.
The focal edema and contusion means the talus has swelling and a bruise. I believe the medial is the outside of the leg. (lateral is inside) (i'm sure that someone will correct if Im backwards)
The ligament part says it is enlarged and edematous (swollen) but sounds like they are intact along with the tendons.
The fluids are the bodies natural protection when the parts are aggrivated.
The no bone chips or defects is good so no broken pieces or cartilage tears.
Other than that I couldn't tell you why you would be crooked except swelling and fluid build up. However dont let them tell you its in your head when you know its not. Switch docs, go to an ankle specialist, be persistant.
Best wishes.

Last edited by moderator2; 03-28-2009 at 05:53 PM. Reason: posted disallowed website(s) - please read the posting rules

 
Old 03-28-2009, 05:31 PM   #4
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Re: Sprained Ankle 7 weeks ago

Your ankle tilt could be the result of weakness in the ATFL (That's Anterior Talo-Fibular Ligament. (try to find a picture of ankle anatomy so you can see where it is.) The MRI says it may be partially torn or weakened.

The bones are held in place by ligaments on all sides. If the ones on one side are too weak, bones might tilt out of position.

Your talus, that's a bone in your ankle, is bruised. Not broken, but that'll still hurt a lot. Your deltoid ligament (another one on the outside of the ankle) is also damaged to some extent.

Bottom line, you shouldn't be walking on this foot. You might or might not need surgery depending on how healing progresses.

 
Old 03-28-2009, 11:11 PM   #5
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Re: Sprained Ankle 7 weeks ago

Crooked Ankle-I'm sorry to hear of your injury. It is painful, I know. I've torn 2 ligaments and had surgery to repair them. As far as your MRI, as the others stated, there is a bruise on your talus or ankle bone and the ATFL (anterior talofibular ligament) might be torn. They think the CFL (calcaneofibular ligament-attaches to your heel) is okay. The CFL is often times poorly visualized on MRI. My MRI stated that mine "appeared" to be intact too, but also said it couldn't see it well. My doctor got into my ankle and found both the ATFL and the CFL were torn. These 2 ligaments along with the PTFL (posterior talofibular ligament) make up the lateral (outside) ankle ligaments. The deltoid ligaments are located on the medial (inside) aspect of your ankle. It is sort of a fan shaped ligament. I think the MRI stated yours was okay. It also sounds like you have swelling which is normal. I agree with Jane in that you shouldn't be walking on this ankle until it is properly diagnosed and a treatment plan is in place. You don't know what the damage is now or what it might become without these things. Plus, with the deformity you are describing, your ankle warrants attention by an ankle specialist. Make an appt asap! Good luck and let us know what happens!

 
Old 03-29-2009, 04:20 AM   #6
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Re: Sprained Ankle 7 weeks ago

Hi there,
Sprained ankles are no fun and take a long time to heal.

MRI comes back saying I have focal bone marrow edema present involving a small portion of the medial aspect of the body of the talus, which probably represents bone contusion secondary to inversion injury.
This is saying basically there is swelling and a bone bruise. Think of an apple getting bruised. My daughter had this finding on her MRI and she was told to not do gymnastics for a few weeks, but she was still walking.

AFTL ligament is normal, but enlarged and edematous, representing strain or partial tear. CFL ligament is probably intact, and is normal in course. The AFTL is the one most often torn and damaged first. It looks like you strained or tore it partially, like a grade 2 sprain.



Small amt of fluid in peroneal tendon sheath. No peroneal tendon tear, subluxation, or significant tendinopathy demonstrated. Peroneal tendons are on the outside of your ankle and run around your ankle bone. It's good yours are not torn. Probably inflamed. I was told by my dr. that after they can take over for the ligaments when they are stretched out or, in my case, ruptured. NO tear is good though, fluid there can cause pain, I'm sure.

Increased signal present in the deep deltoid ligament region, indicating edema related to the acute injury or intrasubstance degeneration of the deltoid. Deltoid is intact. Can't comment here because I don't have issues in this part of my ankle, so not familiar.

[COLOR="blue"][No medial tendon tears present. Some signal in Achilles tendon which is common finding on ankle MRI examinations without tendon enlargement or tears.
/COLOR] Can't comment here either.

Small ankle joint effusion. No loose bodies demonstrated. No talar dome osteochondral defects. You have swelling in the ankle. And a VERY good sign that there are no talar dome defects or loose bodies in there. You don't want that.

What's all this medical jargon mean? Can somebody explain what could cause my ankle to be crooked if there is no dislocations in the ankle joint? Can a muscle, tendon or ligament atrophy and pull my foot into an incorrect position? It's very noticeable - there is a huge difference between the left foot and right foot. I cannot move my foot up and down or side to side. When I do try, my foot goes into a violent spasm. If you don't move your ankle around a lot, then you can lose range of motion. See what your dr. says after the MRI. Mine made me wait 3 months after my ankle injury before he would even do an MRI, so it takes awhile. Ankle sprains can be tougher to heal than a break.

See an ankle dr. and see what he says. 7 weeks is still really early to be fully healed from a sprain.
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Old 03-29-2009, 02:30 PM   #7
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Re: Sprained Ankle 7 weeks ago

Thanks for the information. I guess it's going to take time, patience, and lots of physical therapy. I am thinking that my ankle is crooked because of tight muscles, tendons and ligaments that have hardly been used. You may think I am nuts, but I am going to try anything to get myself better. Last night, I hung my foot out just over the edge of the side of the bed (without the brace of course), and let my foot hang. I fell asleep, and my foot must have relaxed itself. In the morning, my foot was sore but it actually moved into a more correct position overnight. I was able to walk more normally, from heel to toe, rather than using my steppage gait. I admit it was a strange idea, but to me it actually made some logical sense. If the muscles, tendons and ligaments become completely relaxed, then I would believe they would stretch more easily. And if I am going to feel pain, I want to sleep through it. I walked without the crutches today, just the brace. I am going to sleep again tonight with my foot hanging out over the edge of my bed. I will see if my foot begins to feel better just because I am walking on it more correctly. I have a feeling with nothing serious showing up on the MRI, the next step is going to be physical therapy. But I want to get my foot in its correct position before I even begin PT.

 
Old 03-29-2009, 04:01 PM   #8
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Re: Sprained Ankle 7 weeks ago

You know, I always still wear my brace for exercise. It never, even after my first surgery, felt good with exercise without the brace. I'd use the brace any time you aren't walking around the house.
It does take time. I had other issues with my ankle that made me have the surgery. By 3 mos though, my ankle was unstable without the brace, but the ligament pain was much better. So it will get better, but like I said, it was a good 3 months before the ligament pain went down.
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RSD

 
Old 03-30-2009, 07:27 AM   #9
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Wink Re: Sprained Ankle 7 weeks ago

I am still wearing this brace if I have get up and walk around at work or at home. If I am going to be sitting down for a while or I am going to bed, I take it off. I think its good to let the muscles relax, and let the blood get to my foot. Platelets and other substances in the blood help heal the sprain. It will be a long while before I begin an exercise routine. I will definitely need physical therapy first. Even after the physical therapy I will wear the brace if I exercise. I have read it can take up to a year for the ligaments to strengthen after a sprain (that is with proper rehab), and I have also read that it is easy to sprain it again and again once you have done it once. Good idea to wear a brace when you exercise. One wrong move, and you can end up with a sprain again, even worse than the one before.

I am walking better today. Foot and shins got sore by the end of the day yesterday, but felt good in the morning. People at work noticed I am walking better. Brought my crutches if it starts to give me a problem. Maybe I should consider getting some muscle relaxants from my foot doctor. Also, I just started taking glucosamine chondroitin supplements with calcium, vitamin D and soy this past weekend. Supposedly, people with osteoarthritis have found that this supplement decreases their pain just as much as if they used NSAID's (non-steroidal anti-inflammatory drugs) like ibuprofen. My boss takes glucosamine for her knees, and she said she wouldn't be able to walk without it. I can't take ibuprofen because it has given me gastritis, inflammation of the stomach lining. I was taking meloxicam, an NSAID, from my family doctor and it gave me stomach issues too. I hope this makes my foot feel better.

 
Old 03-30-2009, 05:27 PM   #10
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Re: Sprained Ankle 7 weeks ago

Foot is really tired and sore tonight. I hardly used the crutches today, and now my foot feels like I have been walking all day in heels at the shopping mall. It is so sore and it really feels fatigued. I don't think I can completely go off the crutches just yet. I need to wean myself off. Yes I was walking better today, but my foot is not used to all this weight and movement on it. I need to slow down, and ease myself away. You don't realize how much stress you have put on your foot until later in the day. That's when it starts to really bug me. Mornings I am at my best. By evening, I don't even want to be on my feet. Need to find that happy medium with my foot.

 
Old 04-04-2009, 03:10 PM   #11
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Re: Sprained Ankle 7 weeks ago

Decided to walk without the brace and with the crutches for a few days. I felt my ankle and leg muscles had tightened up too much and that the brace is not doing my ankle any good. Thought I would feel better by loosening my tight foot. Ankle swelled up worse than the day I sprained it 2 months ago. It is swollen on both sides of my ankle. The swelling has not gone away. It went down a little bit last night while I was sleeping, then swelled up again today. I feel like I am back where I started.

Tried elevating it and icing it at work yesterday, but that did not do anything to bring the swelling down. It just made my skin burn. I only had ice on it for 20 minutes. Had my shoes off all day at work to help with circulation. I walked everywhere in my socks. Nothing helped.

Got a prescription for SOMA 250mg to relax my muscles and control the spasms. I only began taking it yesterday so it's hard to say if it's helping any yet.

Gee whiz, you would think after 2 months my ankle would not be this bad. You would think it would be fairly well healed by now. But my ankle is acting as if I injured it yesterday. But I did not injure it again. It just swelled up suddenly. Is this normal after 2 months, anyone?

 
Old 07-16-2009, 12:01 PM   #12
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Re: Sprained Ankle 7 weeks ago

It has been five months since I first injured my ankle. Went thru the six weeks of therapy, which ended around the beginning of June. I was still having problems. I had a follow-up with the orthopaedic surgeon. He said it was synovitis in the ankle joint capsule that was still giving me problems. I had a choice between getting a cortisone shot or taking prednisone. Chose prednisone, but had to stop treatment early because of side effects (stomach upset, back pain, insomnia, mood swings). Ankle got better, but still not 100%. My foot still looks crooked. The visible swelling is gone, except every once in a while, but it never swells to the degree it did before. I get pain in the back and bottom of my heel depending on how much I walked on it during the day. I still get pain in the front and side of my ankle, and my foot still looks as crooked as it did when I first injured it. Still feels swollen deep within. I don't know if the deep swelling caused by synovitis is causing my foot to appear crooked, or if something is out of place causing the synovitis. I want to go back to the orthopedic dr. to see about the cortisone shot and a second set of x-rays. If that does not clear up the problem, then I need to get a second opinion. I have been concerned that there is a bigger problem that they have not discovered yet. I will keep pushing the doctors until my foot looks and feels 100%.

 
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