Will PT work for ankle ligaments? - Foot Problems Message Board

rugbygirl15 · 07-20-2006, 05:36 PM

I've had a painful "popping" on the outside of my ankle every time I put weight on it as of late. I haven't injured it since my freshman year (2003- although I probably sprained it a dozen times between 2001 and then between volleyball and rugby) and it's been a little sore after using it, although nothing major. Lately though its gotten to the point where not only does it hurt when I'm using it, but for days afterward, to the point where I don't want to get off my bed.

I finally broke down and went to see my PCP who referred me to an orthopedic doctor. I ended up meeting with him a month ago, and he put me in a boot and ordered a MRI (which they couldn't fit me in until last week

). I just went back to see him this morning to get the results, and he said he found that the ligament on the outside of my ankle was loose, and it was allowing the tendon to shift across the bone. He also said there was a bone fragment in the joint and a cyst (which he said was probably nothing

)on the bone, which were most likely not the reason why I'm in pain. He then said I should undergo PT for 8 weeks then come back to see him.

I was wondering will PT even work to tighten up the ligament, especially since I don't remember doing anything lately that will have caused this

. From what I read (and the thought that the bone fragment isn't going to just go away) I'm not it sounds like I'm just delaying the inevatable, and am going to go back in September and find I have to go for surgery anyhow. What's worse, practice starts up for me the first week of Sepember, so I'm going to miss the first two weeks of the season stuck in this boot (which didn't really help this last month), but if I go in and find that I do have to go for surgery sometime after that, I'd be doubtful for the spring season starting in March. Knowing this is my senior year, and probably the last year I'll get to play, I could try and push it off until next summer, although I'ts almost unbearable now, and I can't imagine it getting any better. I was just wondering would I be better to push the doctor for surgery now, with the hope of being back for the spring, or roll the dice with the PT.

Sorry about being so long winded, I'm just a bit worked up about this, cause barring all the sprains I've never really had a major injury.
-Molly

eko · 07-21-2006, 06:10 AM

Bone fragment in the joint - where did that come from, and I assume eventually it will have to come out or it could possibly do more damage to the joint. PT may help the tendon issue, but I can't help to think something else is going on. Is the OS you saw and Foot and Ankle Specialist? If he is not, or even if he is, I'd see anothe Foot and Ankle OS and get a second opinion, besure to take your MRI with you.

Good luck!
-eko

Bigdog Two · 07-21-2006, 10:24 AM

RugbyGirl:

PT cannot fix loose ligaments. What PT can do is improve your balance and prioperception the strength of the muscles. For many people that sprain their ankles repeatedly their issue it ankle strength and prioperception. So, the usual course of treatment is to be conservative and try PT. Doesn't sound like it will work in your case. Also, I wonder why he put you in a boot. From all that I have read, there is now no evidence that immobilization will work for an ankle sprain. Damaged ligaments don't scar back down with immobilization.

I had a similar situation to you. I had a real bad sprain in college but then contintued to sprain it 10 or 15 times a year thereafter. It didn't hurt all that much afterwards, so I just ignored it. Then playing flag football it twisted up inside the ankle and I was in pretty good pain from there on out. The MRI showed bone spurs and loose fragments in the joint. I also had a tear of the peroneal tendon and badly scarred ligaments. My OS said "lets try PT for 6 - 8 weeks." My PT said "there is nothing I can do for you." My OS said, well, you can have surgery but I'd suggest that you just wear an ankle brace most all of the time." I thought that was crap. I then went to an OS that specialized in foot and ankle surgery. He said "of course PT won't work - let's fix this." So I had two surgeries - an arthroscopic one that cleaned up the joint and then one about 2 months later to repair the ligaments and remove some of the tibia that had grown up due to repeated trauma (this sounds like your "cyst"?).

My advice, get a few more opinions.

kimann · 07-21-2006, 11:22 AM

Molly,
I think your gut response is correct, and you should seek another opinion, preferably from a foot/ankle specialist. If you don't have access to one, try to get an ortho specializing in sports injuries. They will be much more knowledgeable, and will work to get you up faster...
Rest, immobilization, and pt have helped with minor issues, and I don't know why they do this. Just my opinion, but if you are loose enough to have had numerous sprains/strains, you are beyond pt. The bone chip or pieces, too, is something I'd question, makes it sound like you have had a more significant injury at some point, (when you thought you had a sprain), and worked your way through it.
I wish you luck, and hope you will post back and let us know how things go. Kim

rugbygirl15 · 09-21-2006, 03:09 PM

Well, I went for a second opinion, and after doing PT found I have to go for surgery... This second doctor (foot & ankle specialist) looked at the MRI and said that the ligaments looked fine, but one of the two tendons on the side of my ankle is damaged. Despite pretty much expecting this, I still was taken back by it and didn't fully comprehend what the procedure is going to be (I'm starting my list of questions now).

He said something about one of them being strong enough to serve the purpose of both, so he was going to clean out the bone fragment, and remove part of the damaged tendon, and stitch the ends to the existing one

. Is this something that's commonly done? He showed me where he's going to have to cut and it looks like it's pretty major, going along the side of my foot and up behind my anklebone (he said he couldn't promise, but he'd try and avoid the tattoo on my ankle)

He at least gave me the option to wait until winter break to have it done, so I'm looking at early/mid December. He did say with some extensive PT, I might be able to be up and running in three months

(which If I go in December will have me healthy enough for the spring season, although puts a damper on the holidays). I was just wondering if anyone had any insight into what I can expect in terms of recovery time (I go totally crazy if I'm not doing something, so I can't imagine sitting around and doing nothging for weeks at a time)

Mol