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Old 05-06-2012, 11:03 AM   #1
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Red face Ankle Sprain - Increasing pain

Hi,

I have a lot of questions, because I'm confused by conflicting advice I've received. I was in another state when I rolled my ankle and heard a 'pop'. It was in the middle of the night, and although I knew I'd done something wrong, I was half asleep and went back to bed. I woke up the next day and my right ankle was throbbing. I looked down and saw that it was extremely swollen (around the lateral malleolus). When I got out of bed, I could barely walk on it. There was some pain, but it was tolerable. As I walked a little more on it, it began to swell more, and felt more unstable, and there was a numb feeling to it. I decided to go to the nearest ER, because I was thousands of miles away from my regular doctor. Once I got there, I noticed the swelling was getting worse, and some bruising was already visible, around my ankle and my toes. They did x-rays and didn't see any broken bones, but said I had probably done damage to ligaments/tendons, so I should see an orthopedist when I returned to my hometown. They gave me an aircast, crutches, and prescription for NSAIDS, and explained RICE to me. The nurse told me that I needed to stay off of my feet for 6 weeks (!) and if I did not, I would probably end up with another injury, and I'd be back in the ER. I spent the next day and a half icing, resting, and elevating it. I did everything right. However, the next day I had to get on a 4 hour plane ride, where my foot was definitely NOT elevated, followed by 2 hours in the car. When I got home, my foot was swollen and looked like a balloon. I was unable to fit a shoe over it, and it felt completely numb. I could not flex my foot in any direction, and it felt very stiff.

The next day, I made an appointment with a PA at the orthopedic clinic. Since I was given a copy of the x-rays from the ER, they didn't need to take any more. At this point, I had taken a Tylenol 3, and my ankle was extremely swollen and mostly numb. The bruising was more extensive, and went from the top of my ankle, to my toes, and all along the outside of my foot, as well as the sole. I was unable to fit a shoe over my foot, even with the laces undone. The PA took a look at the x-rays and told me he did not see any fractures, but I should come back in 2 weeks for follow-up x-rays to see if there were any fractures that he couldn't detect (?). I was never given a specific grade for my sprain, or told exactly what damage was done. I felt like they didn't think it was a serious injury. When I told them that earlier I'd been warned to stay off it for 6 weeks, they said that I should be using the foot as long as the pain was tolerable. They told me I didn't need the crutches, and could return to work immediately, as long as I wasn't standing. I went to see my regular physician the next day, and he didn't even look at my ankle. He just gave me some exercises to begin doing in a couple of weeks. I still did not get any answers as to what damage there was. Since my job requires standing, I thought I would be off work for a week. Instead, I was given a wooden stool and continued working normally, but in a sitting position. As I sat, my foot became more swollen, and by the end of the day, I was in more pain, and the swelling had increased again. I continued taking ibuprofen, elevating my foot when at home, and wearing my ankle brace when not sleeping.
The next day, I woke up in pain, and couldn't stand on my foot without crutches. The swelling had gone down significantly overnight, but the bruising was increasing, and the pain was worse. I tried to walk on it, since that's what both the PA and my doctor had told me to do, but as I did, it only became more painful. Then, this morning, I woke up in more pain than ever. I actually woke up several times last night because the pain is now radiating from my toes up to my hip. Wearing the brace very painful, but without the brace, my foot feels "loose". I do not have another appointment for a week and a half. Is it normal that the pain is increasing? Why was I given such radically different advice? I feel that the orthopedic PA should know more than the ER about this sort of issue, but now that I'm taking his advice, I seem to be doing worse. I don't want to do any further harm that may last a lifetime. What should I do? I'm sorry about the long post!

Last edited by Succinite; 05-06-2012 at 11:07 AM.

 
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Old 05-06-2012, 11:50 AM   #2
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Re: Ankle Sprain - Increasing pain

If it hurts to walk on it, don't do that.

Sometimes, a minor fracture doesn't show up in the first x-ray, but it does show up in another x-ray a week or two later. I'm not sure WHY, that's just how bones are.

With that kind of swelling, definitely you should be icing a few times a day, keep it elevated above your heart (maybe you can bring a footstool to work?) and keep using the crutches. It might not be 6 weeks, but it'll be some time until it's back to normal.

Sprain is kind of a generic term for soft tissue injury, and it sounds like yours is a relatively bad one. I would make an appointment with a real orthopedist, and keep elevating. The more swollen it is, the harder it will be for the doctor to evaluate your ankle.

 
Old 05-06-2012, 04:28 PM   #3
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Re: Ankle Sprain - Increasing pain

The swelling can (and usually does) mask a fracture when it is as swollen as you describe. An MRI at the six week point should be offered to look for things that are torn and it should also find any little fractures that the Xray missed.

For a minute there, I thought you were seeing my slate of doctors when you talked about how you were treated. I advide you to find another doctor for that follow up visit if you can get you insurance to buy in.

At work you rather need a second stool for your ankle. I am not sure what your job is, but it might work. I teach in a high energy sort of class and while I was off my feet for the first 12 weeks or so, I taught from a stool with another stool for my ankle. Students were more than happy to retrieve things I needed and the front office quit expecting me to run to the phone or up front to the office. (My principal was so surprised to see me walking last week that she commented on it the way a proud mom might comment to her 9 month old just starting to walk. I didn't have the heart to tell her that this was far from over but that I was proving a point to my doctor by following his instructions to the letter. )


My insurance situation is less than flexible, so we have decided to dip into savings to go elsewhere and get a second opinion. I can't live the rest of my life in this kind of pain and always waiting for the next fall and the damage it will leave.
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Old 05-06-2012, 06:33 PM   #4
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Re: Ankle Sprain - Increasing pain

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Originally Posted by janewhite1 View Post
If it hurts to walk on it, don't do that.

Sometimes, a minor fracture doesn't show up in the first x-ray, but it does show up in another x-ray a week or two later. I'm not sure WHY, that's just how bones are.

With that kind of swelling, definitely you should be icing a few times a day, keep it elevated above your heart (maybe you can bring a footstool to work?) and keep using the crutches. It might not be 6 weeks, but it'll be some time until it's back to normal.

Sprain is kind of a generic term for soft tissue injury, and it sounds like yours is a relatively bad one. I would make an appointment with a real orthopedist, and keep elevating. The more swollen it is, the harder it will be for the doctor to evaluate your ankle.
Thanks for the quick reply I have stopped walking on it since the pain became more severe. I've been using the crutches, but the problem there is that it bothers my wrist (which I've had problems with in the past...I suspect carpal tunnel). So if I want to move around, I'm hurting all over. I also live in a 2-story house where the only bathroom is on the 2nd floor, and take care of my little girl by myself during the day, so even when not at work, I'm always having to go up and down the stairs. I've started crawling around on my hands and knees and am feeling pretty depressed right now. The only sitting job they could give me where I work is as a cashier, and the space is small so there is barely enough room for me to sit, so none for an extra stool. The seat they gave me to sit on is about the most uncomfortable stool imaginable - a very short collapsible bar stool. I'm honestly dreading going back there tomorrow, because I'm in twice as much pain as I was last time. I am going to try calling the Orthopedic office tomorrow before work and explaining that the pain is getting worse, and ask what they think I should do. The way they were talking last time, they expected the swelling to go away by now, and me to be skipping around pain-free. I feel quite the opposite. My pain went from a 6 to a 3 and is now probably an 8 or 9. Getting more x-rays in about 10 days, so we'll see if they find a fracture. Thanks again

 
Old 05-06-2012, 06:51 PM   #5
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Unhappy Re: Ankle Sprain - Increasing pain

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Originally Posted by FieryPrincess View Post
The swelling can (and usually does) mask a fracture when it is as swollen as you describe. An MRI at the six week point should be offered to look for things that are torn and it should also find any little fractures that the Xray missed.

For a minute there, I thought you were seeing my slate of doctors when you talked about how you were treated. I advide you to find another doctor for that follow up visit if you can get you insurance to buy in.

At work you rather need a second stool for your ankle. I am not sure what your job is, but it might work. I teach in a high energy sort of class and while I was off my feet for the first 12 weeks or so, I taught from a stool with another stool for my ankle. Students were more than happy to retrieve things I needed and the front office quit expecting me to run to the phone or up front to the office. (My principal was so surprised to see me walking last week that she commented on it the way a proud mom might comment to her 9 month old just starting to walk. I didn't have the heart to tell her that this was far from over but that I was proving a point to my doctor by following his instructions to the letter. )


My insurance situation is less than flexible, so we have decided to dip into savings to go elsewhere and get a second opinion. I can't live the rest of my life in this kind of pain and always waiting for the next fall and the damage it will leave.
Thanks for replying I am sorry to hear about your situation, and hope see some improvement soon. My mother thinks that I'm crazy not to trust the doctor's advice, but I just knew in my gut from the beginning that I shouldn't have been walking around on such a swollen foot/ankle. Now I seem to be paying the price. So, you have to wait 6 weeks to get an MRI? (or at least an accurate one)? That seems like so far away. I'm not sure what to do in the meantime, but I really wish they would explain exactly WHAT my injury is, how severe it is, and what my risks are of repeating this same sort of injury again. I feel like they're dumbing everything down for me, and seem a bit dismissive. I was hoping my regular doctor would be more helpful, but he didn't even glance at my ankle. I've found more information and more helpful people on the internet so far. How sad is that? My insurance will only pay for this particular clinic in town, and I am unable to drive out of town (actually can't drive at all with my foot right now). We don't have a savings, or I would be willing to dip into it. I just hope someone there can actually help me. I've had nothing but bad luck with doctors in the past, misdiagnoses, and missed diagnoses. I guess that's why I really never 100% trust them. I'm sure most really know what they're doing, but I've just had my share of problems. It sounds like you're in the same boat.

 
Old 05-06-2012, 07:05 PM   #6
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Re: Ankle Sprain - Increasing pain

Short answer is, they won't give you an accurate diagnosis because they can't tell, AND because it might not matter.

They can't tell: There's too much swelling. The physical exam tells them very little beyond that your ankle is hurt. The x-ray says there aren't any big fractures. Even an MRI might not be definitive at this point

It might not matter: Most mild to moderate joint injuries heal fine with a simple regimen of rest and ice followed by careful exercise as the joint heals. In this case, you don't need a precise diagnosis.

The most likely thing is that you've partially torn your anterior tibio-fibular ligament, and possibly some other lateral ligaments. That's what normally happens when you roll your ankle inwards. Again, a mild to moderate tear normally heals with rest followed by careful exercise.

In the long term, if the ligament doesn't heal correctly, it could be weaker or even stretched out, which means you'd be at risk of repeating the injury. Worst case scenario (often after repeated sprains that are ignored) is chronic weakness requiring surgical repair, but don't go borrowing trouble. There are exercises to strengthen the ankle, and you must do them eventually, but of course you aren't ready now.

So, call the doctor Monday morning, say it's getting worse, and be insistent. If you need to miss work for a while, how much of a financial bind will this put you in? Do you need a doctor's note for sick leave or short-term disability?

 
Old 05-06-2012, 07:23 PM   #7
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Re: Ankle Sprain - Increasing pain

It is possible to drive with your left foot. That's how I've been driving since early March. You have to be careful in the beginning because you aren't used to how much pressure to use on the pedals. A nice deserted parking lot can help you get used to it.

You are no more dangerous with your left foot than a 16YO just starting out.
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Old 05-06-2012, 07:26 PM   #8
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Re: Ankle Sprain - Increasing pain

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Originally Posted by Succinite View Post
Thanks for replying ... I've had nothing but bad luck with doctors in the past, misdiagnoses, and missed diagnoses. I guess that's why I really never 100% trust them. I'm sure most really know what they're doing, but I've just had my share of problems. It sounds like you're in the same boat.
Holy cow! Are you me??? Do you have military doctors too?

I am planning on driving a couple hundred miles for my second opinion.
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Old 05-06-2012, 07:54 PM   #9
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Re: Ankle Sprain - Increasing pain

Okay, I guess I can live without a diagnosis, as long as it improves (eventually). I probably wouldn't be so frustrated if it seemed to be improving. I'm just upset because I followed their advice against my own personal feelings, and I seem to be doing worse every day. Once in a while I feel a 'grinding' feeling in my foot, and it sends pain shooting through my whole leg. I actually became nauseous this morning. Perhaps it's a mental thing, but the pain is sometimes almost unbearable. I have always had a high pain tolerance. Those that know me well know that I'm tough. I sat through 7 hours of straight tattooing on my back. I've worked with severe kidney infections and fevers of 104. This, however, has me wincing in pain until I'm nearly in tears. I just have a hard time accepting it's just a minor injury, as they seem to think. It reminds me of those coaches in high school that tell kids to "walk it off", you know?

As far as work goes, we are doing okay financially, and my income makes up very little of our overall income. Another issue is that I am taking an online transcription course, which of course requires transcribing, which is done with a foot pedal. I guess I'll be needing to learn how to use my left foot, instead, while somehow propping my right foot up under the desk. I wish I'd injured my left ankle instead! My bad wrist is also on the right side and if it were on the left, I could maybe use a cane. Oh well. Can't choose our injuries, I guess. I do know that my job would definitely require a doctor's excuse for any time off, so I'd need one of those. I also don't really know if they'd allow me to be out too long. I don't want to worry about applying for any temporary disability or anything. I only plan on working there for a few more months anyhow, due to my daughter's school schedule...so if worse comes to worse....Hopefully, I'll be back to normal in a week or two though. I'll just try to think positively.

 
Old 05-06-2012, 08:03 PM   #10
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Re: Ankle Sprain - Increasing pain

I didn't really know if I'd be able to drive with the left foot, but you give me hope, so I'll give it a go.

....and NO, I don't have military doctors. Unfortunately, most of the good doctors don't stay in my town too long, and the ones that do are never accepting any new patients, because they're so popular with their current patients. Also, I've had so many different insurance companies, it seems I'm always bouncing around and never really get to keep the same doctor long enough for him to even really get to know me. My current doctor I've now only seen twice. I've heard a lot of negative things about military doctors, however. They apparently also don't have the best bedside manners (?) I guess it's not that much different out here for civilians, though, unfortunately.

 
Old 05-07-2012, 03:54 AM   #11
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Re: Ankle Sprain - Increasing pain

If I was guessing, I would guess that something is broken or completely torn. Once the swelling goes down and they can get a better look, they will.

Remember - PRACTICE driving with that left foot in a deserted place. You'll have a tendency to use too much pressure and go zooming off or slamming to a halt in the beginning. And DON'T drive while on serious pain meds.
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Old 05-07-2012, 04:01 PM   #12
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Angry Re: Ankle Sprain - Increasing pain

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If I was guessing, I would guess that something is broken or completely torn. Once the swelling goes down and they can get a better look, they will.

Remember - PRACTICE driving with that left foot in a deserted place. You'll have a tendency to use too much pressure and go zooming off or slamming to a halt in the beginning. And DON'T drive while on serious pain meds.
I had a horrible day today (and it's not over yet...ugh). I couldn't sleep well at all last night because the pain kept waking me up. I called the orthopedic clinic as soon as I woke up, but the receptionist was the only one there. I tried to call into work, but they said I needed to find a replacement, or I had to come in anyway. I couldn't get anyone to take my shift, so of course I had to suck it up and go in. I can't explain how much pain I was in, but I felt like passing out, and fought back tears several times. I have felt nauseous all day. Finally, after work, I called the clinic again and talked to a nurse. She told me that the PA says "some pain and swelling is normal" and he'd see me at my next appointment. That's when I broke down and tearfully explained to her that I have a high pain tolerance and this is just too much for me to bear. They won't even give me anything for the pain, so how do they expect me to work and function like this? Ibuprofen is doing nothing for the pain. I even took my last Tylenol 3, and that hasn't even helped a little. I KNOW pain and swelling is normal, but this ridiculous. Child birth was not this bad. Now my foot is very cold and feels like it has no circulation, yet I'm still in a ton of pain. If they can't tell me what's wrong, at least they could give me a doctor's note or something for the pain...ugh.

 
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Old 05-07-2012, 04:40 PM   #13
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Re: Ankle Sprain - Increasing pain

Sorry to hear about your situation When is your next appointment? Could you go for a second opinion?

 
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Old 05-07-2012, 06:03 PM   #14
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Re: Ankle Sprain - Increasing pain

That level of pain so long after the accident is really not right.

Last year I fell and "bumped" my knee. The pain kept growing, so I got it x-rayed at the hospital. They told me it was fine, just a minor sprain. A week later, I finally got in to an orthopedist, who took his own x-rays and found a fracture. Wasn't there in the first picture.

So, yeah. Do you have to work tomorrow also? Call the doctor back and tell them that if they won't do something you'll just have to go back to the ER, as the pain is unbearable.

 
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Old 05-07-2012, 08:40 PM   #15
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Re: Ankle Sprain - Increasing pain

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Sorry to hear about your situation When is your next appointment? Could you go for a second opinion?
Thank you roxygirl for the hug

Although the nurse had dismissed my pain as normal earlier, I couldn't accept that answer. I was told earlier that I should go back to work and try to walk normally. I listened to them, and now I'm in much more pain than I was at the initial time of the sprain. They can't seem to explain why the pain is radiating through my leg and foot. I'm supposed to be icing it 5 or 6 times a day they say now, but that is impossible to do at my job, and this is where most of the swelling occurs. Anyway, I talked to the nurse again and it seems they have quite an open schedule tomorrow (so why are they holding out on me?) so I scheduled an appointment. I'm not sure if they're going to try taking more x-rays or not. The swelling is not completely gone, but has gone down significantly since the first x-rays the day of the injury. I just fear being told "this is normal" when I know that it's not. Later this week, my work restrictions will expire, and I will be expected to stand and walk normally all day. Meanwhile at home, I'm crawling around on all 4s. I just hope they can help me.

 
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