Long term ankle pain

October 20, 2020

I just read a response to “This ankle just won’t get better..” It sounded very good.

I have a somewhat similar problem with a long term sprained ankle issue. My initial sprain was neither a true inversion or eversion. In my early twenties I came down from leaping in the air landing top of toe first with all my movement/force pushing the top of my foot down into the tennis court twisting my ankle and leg at the same time. I heard and felt something give and my foot leg felt as if it was going into or through the tennis court surface. I ended up in a heap experiencing extraordinary pain. I almost lost consciousness and had to be carried to a vehicle. At the hospital I was looked at and given a pamphlet on leg sprains then sent home. I had severe swelling and discoloration all the way up to my knee. My foot looked like a multi-coloured balloon.

It was well over a month before I could put weight on as I had to use crutches. At the time I was a national level badminton player. After my injury I was only able to play at a recreational level, could no longer skip rope/train as I did and eventually stopped in my mid-twenties as I could not spring/move as needed to play even at a recreational level. This occurred over thirty years ago. I remained active weight lifting, long distance cycling, skipping rope all at a level somewhat less than prior but still at an above average level.

Issues started to really come about about in my mid forties. Loss of dorsiflexion, at one time completely after cross country running. In this time I saw a couple physiotherapists, did specific exercises getting positive results. When doing better I resumed hiking, cross-country running, weightlifting etc. and stopped physiotherapy thinking my activity was enough. Unfortunately, after time, the status of my ankle returned to a not so great state with general discomfort, reduced dorsiflexion, knee weakness and now slow atrophy of my thigh muscle. The additional knee and thigh issues concern me. I feel physiotherapy helped me to a degree but only as long as I practiced continually. Also, while immediately beneficial, physiotherapy seems to improved symptoms but did not help heal as I thought it would.

At 53 years of age I can’t help to feel that my physical activities and therapy only postpone the inevitable breakdown of my leg. Am I correct? Should I revisit physiotherapy while continuing to exercise? Is there something else I should look into? I did see a podiatrist three years ago who referred me to a neurologist. The podiatrist could find nothing “remarkable” regarding my ankle other than typical but not significant characteristics associated with long term post sprain injury. I did not see the neurologist as the podiatrist said the only need is if surgery is desired. He stated over half of such surgeries result in no improvement or a worse outcome and I am not a betting man. I very much appreciate your time and any advice, insight you may offer.

October 20, 2020

Hi Donald – thanks for getting in touch.

It seems that you did have an initial massive injury – and with that amount of pain/trauma/bruising/swelling you would have assume that you have probably sustained a ligament(s) rupture (rather than sprain) even maybe with an osteochondral lesion to boot – this is purely speculative and not necessarily factual.

What happens next with seeing lots of good Physios, rehabbing and taking best care and yet it still leads to a weak ankle/leg really does indicate that the next thing you need to do is get an MRI of your ankle to look at the ligaments and bone surfaces.

Generally when things get better, but don’t stay better you do need to inspect the architecture of the joint as this maybe the cause of the ongoing problems, hence why the MRI is imperative for the next step.

If you need any recommendations for decent foot/ankle OS anywhere in the country do let me know and I’m sure I can hook you up with someone decent.

The Guru

Guru Responded

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