I'm a 20 year old female and have been having problems with my right ankle for the past 6 years. I have twisted my ankle so many times. It is always inversion. They have always been little sprains. I don't have to be doing anything crazy. Just walking on uneven ground can mean my ankle will buckle.
Approximately one year ago I badly sprained my ankle and it was so painful. It swelled up and bruised and was extremely painful to walk on for a number of days. I went to my doctor who told me it was probably a bad sprain and told me to try PT. I went to PT for 4 months but then, for financial reasons, could not go anymore so just continued to do the exercises at home.
In the last year I have twisted my ankle at least twice a week. It is so unstable. Some of these have only hurt for a few minutes after occurring but others swelled and bruised. It has come to the stage that when it happens I sometimes end up on the floor not knowing what has happened. It's so annoying because it means that I'm missing out on a lot of sports. My ankle feels really loose and every time I walk it cracks. This cracking is not always painful but it is quite uncomfortable from time to time. Also if I shake my food it is so much looser than my left ankle and makes these horrible cracking noises. Also, I sometimes can just be sitting down and have my foot lying on the floor in front of me and my ankle will just pop out the the side and it's so painful for the split second. My ankle is now constantly swollen and always slightly larger than the left. Also if I move my foot outwards (in the direction it goes when it twists) and then inwards there is a huge pop.
I don't know what to do. I've tried PT and all the exercises and I don't want to go back to my GP and have her tell me that it's fine because it's not and I'm twisting it so often now.
See an orthopedic surgeon who is a board-certified foot and ankle specialist. You may need to be in a solid brace for a while to let it heal. Or, it might require surgery. Either way, that's who you need to see.
You might need an MRI. If you get one before you see the surgeon, make sure you bring the written report AND the actual pictures.
The Following User Says Thank You to janewhite1 For This Useful Post: RachieO (09-13-2012)
I agree with JANE. You need to see a board certified foot/ankle OS (not a general OS or a podiatrist). You need an MRI to see what's going on with your ankle. Your symptoms and occurrence of sprains and instability sounds a lot like mine and you may have some torn ligaments that never healed and may need ligament reconstruction surgery to tighten those ligaments up to prevent future sprains. The fact that you say you feel pops when you evert (turn the sole of your foot out-opposite from inversion when the injuries occur) your foot. This sounds like your peroneal tendons subluxing (popping out over the fibula). That a lot of times requires surgery. I just had surgery for all of that for the 2nd time in Feb. Also the fact that you have failed PT also leads me to think you need an MRI. I would make an appt with a foot /ankle OS soon!
Thank You both so much. Unfortunately my primary care doctor sees nothing wrong with my ankle. He told me it would be expected a year after a sprain. He just said to continue with PT but I really don't know what to do. I know in my heart of hearts that something else is wrong from the way my ankle moves and pops and snaps and hurts. In my town you need a referral by a PCP to see a surgeon and seeing as my PCP won't refer me, I'm stuck. I've never had trouble with joints before and it's so frustrating because it'll give way all the time.
Any suggestions to stop this happening? I'm doing my PT exercises religiously.
No, pain a year after a sprain is not normal. It's a sign things haven't healed normally. Is there any way you can switch to a different PCP, possibly one with a more aggressive attitude toward orthopedic problems?
Pain a year after a sprain is not normal at all. It's highly suggestive of further issues. Is there nothing you can do to be referred to a foot/ankle ortho? I hope you can get seen. I know how hard it is to struggle with the pain of an unstable ankle,
Actually have good news! Changed my PCP and am going for an MRI soon. She thinks the ATFL is torn and she said maybe there's some problems with the peroneal tendon but she said that that may not show up on an MRI.
Was wondering what the treatment usually is for a complete ATFL tear and also if any of your peroneal tendon problems appeared on the MRI scan?
Yay! Sounds like you have a good PCP now! She sounds like she knows a bit about ankles which is great. I'm glad she's getting an MRI for you, but hopefully she'll refer you to a foot/ankle ortho after you get thr results. As for your questions. I had a completely torn ATFL and CFL and a longitudinal tear in my peroneal longus tendon (surgeon told my husband it was "shredded"). I had surgery to repair these 3 plus the retinaculum and an osteotomy to deepen the groove so the tendons wouldn't pop out. This was my 2nd surgery so I didn't so much have to do all the conservative stuff this time. Before my first surgery, we tried conservative measures and I failed them and had the first surgery. I would be happy to answer any and all questions you have because I'm very familiar with your exact injury!
Yes, if a ligament is completely torn, surgery is usually the best option. (If it's only partially torn, conservative measures usually work if applied correctly from the beginning. Conservative measures MAY work on an older injury.)
The thing about ankles is, the MRI isn't always 100% accurate, since ankles have so many different tiny little parts. Get the MRI, make sure the prescription includes your doctor's tentative diagnosis. Make sure you get the actual films on CD or in the giant envelope.
If your PCP is unwilling to refer you, on your request, to an orthopaedic surgeon, you need a new PCP. If you have that much instability, you need to see an ortho and get X-rays and an MRI. You didn't mention... have you ever had an x-ray? You could have an avulsion fracture from one of your many sprains that could also be leading to the popping.
I would go get a different PCP and def go to see an orthopaedic surgeon!
Again, thank you all so much. It is so lovely to come on here and talk to people who know exactly what it is to have ankle problems. They may not sound debilitating but when you're walking round and just hit the deck because of it it's embarrassing.
I suppose I'm just going to describe something and see what you all think. When I'm in a position where I have some weight on my injured ankle and I raise my heel of the ground so that it's just my toes and balls of my foot on the floor and then I position my foot so it's kind of pointed to the side and then move my heal from left to right there is this really loud pop. It's is audible by the people around me and it makes them cringe a little. I was wondering what this sounds like. Incidentally it's the exact same "pop" that I feel when my ankle twists or gives way. It probably sounds silly but I just thought I'd describe it.
Also would 4 months of PT and continuation of PT exercises with no improvement be seen as failed conservative treatment?
Again, thank you all so much. It is so lovely to come on here and talk to people who know exactly what it is to have ankle problems. They may not sound debilitating but when you're walking round and just hit the deck because of it it's embarrassing.
I suppose I'm just going to describe something and see what you all think. When I'm in a position where I have some weight on my injured ankle and I raise my heel of the ground so that it's just my toes and balls of my foot on the floor and then I position my foot so it's kind of pointed to the side and then move my heal from left to right there is this really loud pop. It's is audible by the people around me and it makes them cringe a little. I was wondering what this sounds like. Incidentally it's the exact same "pop" that I feel when my ankle twists or gives way. It probably sounds silly but I just thought I'd describe it.
Also would 4 months of PT and continuation of PT exercises with no improvement be seen as failed conservative treatment?
Thank You
You definitely need to see a foot and ankle OS.This is obviously beyond the expertise of your GP. I agree with all the above posters that you need a proper diagnosis. You have to be proactive order to resolve this ankle problem.
Well I got my MRI results back on Friday. They say that there is some muscle damage. A tear in the ATFL and tendon damage. There is also evidence of an ankle fracture.
Do you think that this will be treated conservatively or with surgery?
Probably depends on how the fracture appears to have healed and the extent of the tear in the ATFL. Additionally, it will depend on how active you are and if you want to continue to fall down while you are walking because your ankle gives out.
I had a tear in the ATFL for years that allowed for multiple ankle sprains, but would heal to the point that it wasn't painful. I did not agree to have it fixed until the point where the instability was causing constant pain/swelling in my ankle and the sprains would no longer "get better". It became a quality of life/activity decision for me.
The Following User Says Thank You to straighttoe For This Useful Post: RachieO (09-26-2012)
I am extremely active. I play tennis and the injury has stopped me because any time I change from one side of the court to the other my ankle gives out and I'm on the ground.
I jog twice I day and it has now come to the points that I fall over any time I stand on uneven ground.
I also surf, and can't do this anymore either because I just wipe out any time I lead with my injured leg which incidentally is the leg I naturally lead with.
As the regards the fracture. Is it normal for a fracture to still show on an mri about a year after the injury?
Did you met with an orthopaedic surgeon prior to the mri?
A lot will depend on what was fractured. You can have an avulsion fracture, which means a piece of your ankle bone broke off when the tendon and ligament stretched and tore. The piece of bone would most likely be detached and be "evidence of a fracture".
In my case, the medail maleolus (inside ankle bone) had an avulsion fracture which occured from my ankle moving inward too far (inversion) and causing the end of the ankle bone (tibia) to break off. The "piece" worked into a position that was limiting mobility, so I had the Dr. take that piece out during one of the surgeries.
If you want to try to get back to all your activities, you will most likely opt to get the ligament repaired... google brostrom procedure, which is the most common repair for that type of ligament tear.
So I went to see my ankle surgeon today. Unfortunately it's time for surgery. I'll be having the ATFL repaired and also sorting out my torn peroneal tendons. There's some bone fragments floating round in there too so they'll be removed!
I'm a little worried about surgery. Has anyone has this kind of surgery? My surgeon had to leave my appointment early as his wife went into labour-typical me! Because of this he didn't get to go into a lot of detail. How long does this surgery last? How long is the hospital stay? What's the pain like after? How long in a cast? How long should one take off school, I'm a med student so spend a lot of time on my feet! Also, had the surgery a good outcome?
I had arthroscopic surgery on my other ankle a couple of years ago just to clean out some bone chips, I dealt pretty well with this and didn't really feel any pain but I understand that this was a lot simpler and I was weight bearing after a week! How much worse will this surgery be?
I'm so sorry for all the questions! I'm just a little nervous about the whole thing!
__________________
Rachel
Holder of a rather wobbly ankle
Type 1 Diabetic and Pumping with Animas Ping
Sorry to hear what you're going through Rachel...I personally don't have the same condition as you but from what I have read it is a pretty long recovery. I am sure someone else can tell you more. My guess would be at least 6 weeks NWB but I am not sure. You've definitely come to the right place for advice.
I had arthroscopic surgery on my left ankle April 2010 to remove damaged cartilage, drilling was done to help rebuild new cartilage. I was not able to do any supervised PT due to financial reasons but did exercises at home for 2 weeks. I am quite sure I did not do enough PT and am wondering if my ankle will ever be 100% because I did not go to PT like my surgeon advised.
Cold weather seems to stiffen the area still but the surgery was so long ago.....why still stiff?
I went on a 30 mile hiking/camping trip with my Dad and it held up VERY well. I never once had to baby the ankle nor did it get stiff, sore, and best of all I was able to wear a backpack with moderate weight. We were in Montana and the terrain was nothing short of "EASY!!!" We were both surprised how well my ankle did.
It is strange because I can play sports, hike, run, climb and have no issues BUT out of the blue like this morning....and I haven't exercised lately or jumped or put any strain on the ankle and it is sore and sharp shooting pains and it has been popping and clicking off and on. ??? Please any advice until I can go see my surgeon again.
She thinks the ATFL is torn and she said maybe there's some problems with the peroneal tendon but she said that that may not show up on an MRI.
