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Old 03-12-2012, 10:02 AM   #1
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Lingering ankle sprain

I sprained my ankle back on 7/1/11. Treatment included x-rays (no fractures) and an aircast/splint that I should wear until my pain subsided. Iced, elevated and wore the splint as directed. I never had as much pain walking on it as I thought I would. It would throb though, at rest. Almost a stabbing pain from the outside malleolus. No real bruise other than a light bruise around the malleolus on the outside of the ankle for a few days and then it was gone. It was very tender over the malleolus. It swells, but not an unusual amount, around the malleolus on the outside, over the top of my foot, into my toes and around the back of my ankle where the achilles is. Fast forward to August and I still can't do any prolonged walking, ankle is very stiff and sore - mostly a moderate ache. Go to a podiatrist, she says I need PT and to continue icing, more x-rays taken, show nothing. Gives me a lace-up splint to wear, which feels great. My giat is affected and very uneven, my left ankle and foot feel like dead weight - very "wooden" as opposed to the normal, flexible feeling I have in my right foot. Swelling goes down a bit, PT is great but when the ankle improves I now have pain up into my calf. they work on the calf pain, tell me I probably have adhesions, and the pain is so great when they work on the calf that I almost cry. But, after the calf is worked on it feels much better. Continue with PT from end of August through to mid-October. I get most of my flexibility back, Podiatrist says it could take six months to really heal. Continue to work with a personal trainer to address my weakened leg, core and hip/glute muscles once a week from end of PT to present. Make huge strides in muscle strength, but ankle pain never really goes away. I cannot walk a long distance without pain over the top of my ankle, more towards the inside. Cannot jog at all, and before the sprain I was a casual runner. I can only wear my trusty sneakers or other shoes with cushiony support. There is still residual pain and stiffness at or around the outside malleolus. Sometimes there is increased sensitivity to touch around the outside malleolus, especially when the weather is damp/rainy. My calf is still painful up towards my knee, on the outside of the leg, lots of stiffness and soreness in the back of my calf/lower leg in the area of the achilles. The outside of my foot is very stiff and often sore. I've put arch supports in some of my less supportive shoes and that helps a bit. Going to the ortho on 4/26 but any ideas of what could be wrong? I am still working with the personal trainer but we modify so my ankle and foot are not stressed. I have poor lateral balance on the left foot too, although we have worked consistently at improving it. Foot is still somewhat puffy too around the outside malleolus and at night often into my toes. Needless to say, this has caused me a lot of anxiety and emotional distress. I have not been able to return to activities I took part in prior to the ankle sprain.

 
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Old 03-12-2012, 04:27 PM   #2
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Re: Lingering ankle sprain

Has anyone ever checked for peroneal tendon damage? Ask for an MRI and an ultrasound of the tendons.

 
Old 03-12-2012, 04:42 PM   #3
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Re: Lingering ankle sprain

It could be a tendon tear. I sprained my ankles in August. MRI did not show any tears but after trying all conservative measures, my surgeon felt I had a tear (all symptoms were consistent with a tear). Went in and yup I had a tear.

 
Old 03-12-2012, 07:31 PM   #4
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Re: Lingering ankle sprain

I actually had a similar story. Turned out the puffiness over the lateral malleolus was scar tissue inside the joint, impingement syndrome. It was repaired with a fairly easy surgery, and I am now about 98% better.

As for the calf, keep massaging those muscles. Your stiff foot forces you to use them abnormally, which makes those ugly painful knots show up. I used to roll a ballpoint pen up and down the side of my calf!

 
Old 03-13-2012, 12:59 AM   #5
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Re: Lingering ankle sprain

I also have a similar story and I too,was going to say they need to check for peroneal tendon damage. I had a lot of the same symptoms you did and my OS knew I at least had peroneal tendinitis and suspected a tear. MRI came back suggesting a tear. I had surgery 3 wks ago to repair ligament and tendon tears and when he got in there the tendon wasn't just torn, it was shredded! The peroneal tendons are frequently injured in an ankle sprain b/c there job is to prevent sprains. When you ankle rolls out and your foot turns in (inversion), the tendons fire and pull up to prevent the sprain but sometimes it doesn't happen and they tear in the process. It's fairly common but never suspected at first for some reason. As far as the knots in your calf near your knee on the outside....very typical given your symptoms. Those are your peroneal muscles that the tendons are attached to (tendons connect bone to muscle where ligaments connect bone to bone) and just like when you get knots in your neck/shoulders during over/misuse, you can get them in your leg to. They are painful knots and having them worked on is the best thing you can do for now and later when your ankle is healed, you can stretch that area too. Hope this helps and let us know what your OS says!

 
Old 03-13-2012, 05:23 AM   #6
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Smile Re: Lingering ankle sprain

Thank you all SO MUCH for your insight. I can't even express how much relief this gives me, and it gives me some ammo for when I go to my appointment. Plus it's great to know that surgery helped, if i have to go down that road. Thank you thank you

 
Old 03-13-2012, 07:15 PM   #7
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Re: Lingering ankle sprain

I'm surprised they haven't sent you for an MRI yet. Ortho probably will. You could have an OCD ... osteochondral deffect on your tallus??? only a guess as you are describing some of what I have been through.

 
Old 05-21-2012, 06:01 AM   #8
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Re: Lingering ankle sprain - UPDATE

I went back to the doctor last week, after having an MRI a few weeks prior...

My official diagnosis is Os Trigonum Syndrome. There is swelling in and around the Os Trigonum bone. Because I already completed and failed conservative treatment, they are looking to fix it surgically, since it's a chronic condition that will not go away on it's own and will not be "fixed" by injections, other than for some pain relief.

At this point, it's causing me so much discomfort and is starting to affect my knee and hip, that I want it fixed. So I go back in June to further discuss that option and scheduling. Sigh.

 
Old 05-21-2012, 06:21 AM   #9
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Re: Lingering ankle sprain - UPDATE

I had an os trigonum along with several other things.. the os trigonum excision was not a real big deal other that it is surgery and you will be sore.. GOOD LUCK!!

 
Old 05-21-2012, 09:18 AM   #10
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Re: Lingering ankle sprain

I agree with straighttoe, the os trigonum removal is not a terribly difficult surgery. No operation is really trivial, but this one isn't bad.

Since you've tried conservative treatments and the pain didn't settle down, surgery is probably the best plan. Do go to the next appointment with plenty of questions, such as when you'll be able to return to work, whether there will be PT, etc.

Get the PT if at all possible. The surgery isn't a big deal, but at this point limping has probably become a habit for you, and a good PT can train you out of that. Also, I imagine you've lost muscle in the affected leg.

 
Old 05-21-2012, 05:20 PM   #11
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Re: Lingering ankle sprain

Glad to hear you found out the problem! I went almost 2 years with subluxation of both peroneal tendons before I go a diagnosis. I had an OS who wouldn't listen to me and focused only on my fracture. After a second opinion (who diagnosed me within 3 weeks ) I am now awaiting an appointment with a different surgeon. Looking forward to having it resolved!!

 
Old 05-23-2012, 05:34 PM   #12
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Re: Lingering ankle sprain

Thanks everyone. I am somewhat relieved to have a diagnosis. I will go armed with questions. And yes Jane, i will be doing PT, and have actually done it all along, and am still working with the same PT people until I go to surgery. I am not going to let my body get all out of whack waiting for this to be fixed. I guess my only concern is, with the laxity of my ankle and the constant snapping of the ligaments - the PA i saw said to me that if the ligaments are loose, they will fix them when I have the os trigonum removed. I think that is a little more of an intense recovery, yes? Luckily I have STD at work, so I should be all set, but I am a huge sissy. I don't like being restricted or in pain

 
Old 05-24-2012, 01:04 AM   #13
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Re: Lingering ankle sprain

Yes it you have the ligaments or tendons fixed, it is definitely a much longer and involved recovery. I just had ligaments repaired, tendon repaired and the bone broken and drilled so the tendons won't pop out on 2/22/12. Crutches 6 wks NWB in a cast (but almost 8 weeks before I could get off crutches completely) and I'm on week 7 of PT!
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Brostrom-Gould, repair retinaculum, peroneus longus tendon repair, fibular groove deepening for peroneal tendon subluxation- 2/22/12
-Modified Brostrom (failed)- 8/15/01"]

 
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Old 10-13-2012, 08:48 AM   #14
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Talking Re: Lingering ankle sprain

So I did it. On Wednesday I had a Brostrom repair, Os excision, ligaments tightened and my peroneal tendon tear repaired.

I feel remarkably and surprisingly great! Thankfully I live in a ranch style house, that is NOT very large, so getting around on crutches is pretty easy, though tiring, and I was/am in pretty good shape prior to surgery. I can't stress enough how important it is to build upper body strength and the hip and quad/hamstring strength in the "good leg." If I was any less in shape well...I would be exhausted just from using the bathroom!

They gave me a nerve block and put me under during the procedure. I was VERY worried about being put under and about the huge needles they use during the nerve block but honestly, it was no big deal. The nerve block didn't even hurt until they put it in my calf, and even then, i was sedated pretty heavily and it was over before i knew it. I woke up in no pain, parched and starving! I've got a splint that goes up to my knee and have yet to have any pain that requires percocet. Icing and elevating are KEY. As the nerve block wore off I had some calf pain and spasm, but only a few times over 24 hours, but that was yesterday and today I am feeling pretty good. My toes do hurt in a pins & needles type fashion, but I suspect that's partly because I can't really move them and they may have fallen asleep! the more i wiggle them the better they get. the surgeon and surgical staff were AMAZING, took all of my fears and anxiety very seriously, and treated me like a queen. I feel so lucky.

I've been doing some single leg raises and isometric exercises for my thighs and hamstrings and to keep my strength in tact, as the crutches are killer if i am on them for too long. going down the three stairs to get out of the house is a piece of cake but coming back in, esp the top step over the threshold, is scary so for now i am staying put if possible. my knee and hamstrings are sore from the nerve block injection site (behind the knee) and from carrying this heavy split around! I have a post-op on the 23rd when they should put me in a regular cast and i can start bearing some weight. I can't wait!

 
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