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Old 06-16-2012, 03:10 PM   #1
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chronic ankle pain, desperate for answers!

Hi,

Sorry if this thread is very lengthy but there is a lot of info I need to cover! So... I was a competitive gymnast and two years ago injured my left ankle. I chipped some bone off the talus so had pain in the front of my ankle and also medially behind the medial malleolus.

A year later, still with pain restricting my gymnastics, I had an operation to remove the floating bone in the front of my ankle after relief of pain from a cortisone injection. I also had an injection to the medial side of my ankle which made no difference to the pain.

After the operation to remove the floating bone, my ankle healed relatively quickly and the pain in the front of my ankle had gone! I still had this pain on the inside of my ankle though. The pain is worse when my ankle is in a dorsi-flexed position i.e landing from a height, squats etc, i would get such a sharp pain in that area I couldn't even face tumbling again, so I retired from gymnastics. My operation was in sep 2011.

In Feb of 2012 I fractured the lateral maleolus in the same ankle twisting it while running, my ankle wrenched outwards and that was it... After the cast came off my ankle was very stiff and still is but is getting better. But the pain on the inside is worse now than before so had no relief from the 6 weeks of rest! my physio has done massage on the area which gives only temporary relief i.e a couple of hours, also the inside of my calf extremely tight and tender, not sure if this is linked.

I have seen a podiatrist who has given me orthotics as my foot seems to be 'colapsing' inwards presumably due to the injury. This however has made no difference and I am now getting sharp pain in my achilles tendon and behind my lateral malleolus when I point my foot.

If anyone has any advice on what to do next, or what any of this could be I would be truely grateful as I feel I am getting no answers nor relief from pain!!

Thank you

 
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Old 06-16-2012, 06:59 PM   #2
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Re: chronic ankle pain, desperate for answers!

Your foot is collapsing inward and hurts on the inner ankle. Like your arch is falling?

That could be posterior tibial tendon tear. If that's the problem, and arch supports aren't helping, you should see a board-certified foot and ankle surgeon. (Not a podiatrist, an orthopedist.) Immobilization might help, if not, surgery to repair the tendon is an option.

Or, it could be something else. But definitely, see the best foot surgeon you can find.

 
Old 06-16-2012, 09:23 PM   #3
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Re: chronic ankle pain, desperate for answers!

Hi! Welcome to the boards! I understand where you are coming from as I used to be a gymnast myself and that is also where my ankle injuries started. I agree with JANEWHITE that it sounds like it might be a posterior tibial tendon issue. However, the pain you are still having on the lateral side of the ankle behind the lateral malleolus would be peroneal tendons. You could have both going on. I just had my 2nd ankle surgery in Feb and had 3 ligaments plus a peroneal tendon tear repaired as well as the fibular groove drilled and broken to deepen the groove so my peroneal tendons won't pop out anymore. I say that to say that you might have a peroneal tendon tear or they might be popping out. This generally occurs with traumatic injuries such as the twisting outwards you described. But it does sound like something is going on with your inner ankle and "arch collapsing" is usually a classic sign of post tib tendon injury or dysfunction. Please do see a board certified foot/ankle ORTHOPEDIC surgeon. Let us know how it goes! And feel free to ask any other questions you have because there's a wealth of knowledge on this board and chances are if you have a question about it, there's someone on here who's been through it!
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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"]

 
Old 06-17-2012, 12:56 PM   #4
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Re: chronic ankle pain, desperate for answers!

Thank you very much for your replies. I have researched posterior tibial tendonitis and the thing I am confused about is the fact that I have no pain running down my foot, the pain is very much isolated to the part just behind the medial malleolus. Could this make a difference?

Also the recent pain in my achilles, could this be to do with the recent insertion of orthotics, or just a continuation of the old injury?

I am thinking of seeing a physiotherapist as to see an orthopedic surgeon could be months down the line as I would have to go through the doctor first, do you think this is a good idea in between?

 
Old 06-18-2012, 12:22 AM   #5
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Re: chronic ankle pain, desperate for answers!

Hi! Post tib tendinitis can exhibit pain only behind the medial malleolus I believe. It may be something you're catching early. Where do you live? You mentioned it taking a while to see a foot/ankle OS so I wondered if you lived somewhere that has an NIH. As far as the physiotherapist. I'm not sure how it works where you are, but in the US, you have to have a doctor's order to see a PT and even then, they treat what the doctor has diagnosed in compliance with the overall treatment plan. They don't diagnose the problems...well, not initially anyway. If things arise during your treatment, they can generally spot it and ask you to ask your doctor about it. At least that's what happened with me. So to answer your question, I'm not sure. If you are going to get interim treatment for pain control or to stop progression of the injury (say like the overuse injury tendinitis) while you wait for further treatment with the foot/ankle OS, that's probably a great idea. But not knowing what the injury is and not knowing what physiotherapists can and can't do where you are, I'm not sure. I do know that I would get on the waiting list for the foot/ankle OS! You definitely need to be evaluated by one! Good luck and let me know what you think and what the roles of PTs are where you live!
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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"]

 
Old 06-18-2012, 02:01 AM   #6
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Re: chronic ankle pain, desperate for answers!

Ok thank you very much. I live in the UK where we have an National Health Service. Basically to be evaluated by a surgeon you have to go through your GP doctor (who generally has no idea what you have! Especially if it is sport related!). The waiting list is generally months long. It took over a year to have the bone excised from my ankle! You can also see a physio this way (which will be free) but again massive waiting list and generally people's problems have resolved by the time they actually get seen by anyone!

Alternatively you can pay privately to see a physio. You get seen almost instantly but the session's are around £40 each so if you have to see them a lot it can be quite expensive. If they suspect you need an MRI you can either pay to have it done. you're talking £300!... Or again, get it done on the NHS for free and wait... These physio's can diagnose though.

It's a very frustrating system, and unless you are willing to pay health insurance at stupidly high cost you have to wait for treatment (unless of course it's an emergency), but at the moment mine isn't!

I think I will go to my doctor and see if I can see my consultant from my last operation, that way I might be seen quicker. In the meantime I am going to book one private session of physio to see what they think. Thanks again for your reply!

 
Old 06-19-2012, 01:29 AM   #7
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Re: chronic ankle pain, desperate for answers!

Based on the info you gave me about all your choices and that physios can diagnose, I think your decision is a good one! How frustrating that you either have to pay an arm and a leg to get anything done when you need it OR have it paid for free, but wait for forever until it's resolved or in some cases...too late. I'm so sorry! It does sound like you've thought it out and made a good choice! Good luck and please be sure to come back and let us know what the physio and the doctor says and I hope you get in with the consultant you've seen previously fast!
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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"]

 
Old 11-27-2012, 11:16 AM   #8
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Re: chronic ankle pain, desperate for answers!

See below for latest post!

Last edited by apalmer8; 11-29-2012 at 04:21 AM.

 
Old 11-29-2012, 04:20 AM   #9
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Re: chronic ankle pain, desperate for answers!

Quote:
Originally Posted by Hollywood48 View Post
Based on the info you gave me about all your choices and that physios can diagnose, I think your decision is a good one! How frustrating that you either have to pay an arm and a leg to get anything done when you need it OR have it paid for free, but wait for forever until it's resolved or in some cases...too late. I'm so sorry! It does sound like you've thought it out and made a good choice! Good luck and please be sure to come back and let us know what the physio and the doctor says and I hope you get in with the consultant you've seen previously fast!
Hello Hollywood48,

So itís been about 5 months since I last posted on here, and a lot has happened, regarding my ankle.

I went to see the doctor soon after, and they referred me to a physio who practiced at the doctors surgery so to my pleasant surprise I had an appointment with him very swiftly. He couldnít diagnose but thought there were a number of possibilities that could be wrong and that most likely ankle arthroscopy would be needed. Although he did warn that it could be invasive and to weigh up the risks.

He put me through to a consultant at the hospital who found that stressing the peroneal tendon did not produce pain, although palpation did, and so ordered an MRI as he suspected maybe there was a bone spur or something like that could be causing pain.

By this time, I had started trampolining training at my uni, which satisfied my craving for gymnastics quite nicely! About a month after starting i suddenly developed very acute lateral heel pain. And I mean acute... I was running and felt pain and then bouncing on the trampoline was impossible. I just put this pain down to starting something too much too soon and thought it would go away by itself with ice elevation etc. When I went for the MRI I noted that this pain was new so that the radiographer knew to look in this area.

To my horror when the results came back, I had a calcaneal fracture (and yes fracture not stress fracture)... which i had been training on for about a month! I was warned that if I carried on this could displace and then I would really be in trouble!

I had to wear a walking boot for 2 weeks, which has just come off, yay! But I have to refrain from physical activity for 2 months ...

I am worried about my other ankle, as about 2 weeks after my left was hurting, my right heel started hurting and was EXACTLY the same as the other heel. Do you think if I fractured that one too it will heal just with rest??

Also something else came up on the MRI... It showed I had a large Os Trigonum which is causing impingment at the back of my ankle... hence the deep Achilles pain. I am undergoing a steroid injection in Feb next year and then an operation to remove the Os if successful.

I have a couple pf questions:
Is it normal to fracture that easily? Seeing as nothing happened specifically, and the fact that I have the same pain in both heels? Should I be concerned about weak bones?

Should I talk to the consultant about the other heel when I next go to see him? Or just see if it heals by itself?

Has anyone has Os trigonum surgery? Or know about it? Recovery time, returning to sport? Etc. etc.

I'm so upset, I've already had surgery on my ankle and fractured it after that, I just want to be able to do sport/activity with no pain!!

If you or anyone has any advice it is much appreciated!

 
Old 11-30-2012, 01:46 AM   #10
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Re: chronic ankle pain, desperate for answers!

I would probably ask about the other heel, yes. As far as it breaking without you recalling any injury, I would also ask about bone density. Might need to do bone density testing. Might need to increase your calcium intake, but I am not a doctor and I'd bring all this up with your treating physician and see what s/he says. I would def bring up your other heel to see if you can head it off!
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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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