Prognosis - Right Ankle?

[physiobob]

Suggest you discuss this further with your orthopaedic surgeon

[dibblego]

I just found this story which sounds remarkably like mine.

[physiobob]

First rule as a patient. NEVER diagnose yourself based on someone else's problem. Secondly you have your MRI. If the report says there is NO fracture then basically there is NO fracture. Please go back and consult your orthopod (or a second opinion). The appearance of your ankle is nothing like CPRS so forget about that one. We cannot provide any more advice without a physical examination. Sorry but that's the limitation of internet based forums at this time

[dibblego]

Please be assured that I am not diagnosing myself - merely observing some similarities (I have also seen many dissimilarities). Nevertheless, I still sit here, 535 days after the injury, without a diagnosis and finding it difficult to walk after seeing:

2 Orthopaedic Surgeons
2 Physiotherapists
2 GPs
1 Sports Physician
1 Podiatrist
1 Occupational Therapist

I am going to write a document detailing full history, symptoms, images, etc. Hopefully then I can present a fuller picture.

Thanks for your help so far - I expect to hear from the Orthopaedic Surgeon tomorrow when he receives the films from the latest MRI.

[dibblego]

The surgeon says "Nothing indicated on MRI. Bye." What now? I'm trapped in my house for the remaining years of my life? I had no idea I would get to 18 months without a diagnosis - please excuse my frustration but this is ridiculous. Help?

Given that many doctors have said "no sign of fracture" according to all images, despite my insistence that "the pain is coming from the bone", then is it possible that I have had a syndesmotic injury with diastasis that has been missed? Especially since it was 6 months after the injury before I even approached doctors (I used to be invincible!). I have no idea what this might feel like or what symptoms I should have, but I can pin-point my pain and you can see that my foot is the wrong shape - I walk with it pointed outward and have no dorsiflexion (if I attempt it I get pain then a physical limitation - like a bone hitting a bone).

I still plan to document a full history of this condition properly so as to pursue a diagnosis and possible treatment.

[physiobob]

If ortho is done with you, then they are done with you. You now need to see a neurologist to look at the nerve potentials in the leg (EMG) to see if that could be an issue. I would also try to get a bone scan. Nothing more we can do until you get the results of those investigations. I think you best take an approach of ruling out things one by one.

[dibblego]

I had a bone scan on 06 January and although the picture has a lot of emphasis around the area of my ankle joint, the radiographer report reads nothing remarkable and nobody else who has seen it seems too concerned. The report is below.

I'd love to rule things out one by one, but I've no idea where to start. Can you provide any tips besides nerves (which I will do although I am a little sceptical)?

One other thing; is there such a condition where the ligaments are damaged so that upon dorsiflexion, the talus cannot move backwards since it is hitting the tibia and/or fibula? If so, what is it called and how is it diagnosed (I have determined that in general, doctors are significantly more prone to confirmation bias than I am)? Is it known to drive people crazy so that they post all over internet message boards because NWB images have failed to show up a diagnosis? Just an intuitive thought.

I really need a diagnosis but I'm struggling to determine what to do next. All I can do is try to provide a full picture of my history and provide a comprehensive explanation of my symptoms but this has so far proved fruitless. Help!

BONE SCAN

HISTORY
Acute localised pain lower third fibula

TECHNIQUE
Three phase 99m Tc - HDP bone scan of both ankles and feet including
delayed images of both knees. Correlation is made with prior MRI right
ankle of 17/11/2008. 15/09/2008 - Broestrom Repair and medial ligament
repair.

REPORT
The early images show moderate increased vascularity in the right
ankle medially and laterally, especially medially.In the delayed
images, there is moderate to intense uptake adjacent right ankle,
especially in the right medial malleolus and distal tibia anteriorly.
There is mild to moderate uptake in the right subtalar joint.

There is mild periarticular uptake in the small joints of both feet
including the first MTP joint in keeping with mild degenerative
change. No intense focal increased vascularity is identified in the
distal third of the right fibula.

OPINION
1. Moderate to intense bone reaction adjacent right ankle, especially
medial malleolus and distal tibia anteriorly with increased
vascularity. This is presumed to be due to recent post surgical change
and there is history of corticosteroid injection. On its own, this can
be seen with synovitis. More intensse bone reaction in right medial
malleolus is presumably related to medial ligament repair.
2. No intense bone reaction identified in distal third of either
fibula to account for patient's presentation.

[physiobob]

An anterior impingement will prevent or cause pain on dorsiflexion. This is rather common though not often diagnosed as such. Suggest going to see a foot specialist who work with the ballet and athletic population. I would not be skeptical about EMG tests as your muscles don't appear to be behaving normally.

[dibblego]

Thanks for your patience.
By foot specialist, do you mean an orthopaedic surgeon specialising in lower limb or something else? Excuse my ignorance.

[dibblego]

Update.

Sorry but I take it all back. There is without a doubt a bone irregularity/discontinuity in both my tibia and fibula that is incredibly, immediately and unwaveringly obvious. It feels like a previous fracture though I am not qualified to say. I have had two registered nurses (one also a practising midwife) confirm this observation with absolute confidence. It can be felt through the skin and I am no longer open to any other suggestion besides a bone problem. I suspect that this also explains my bone impingement upon dorsiflexion since the joint is out of shape.

Question: why can I only sometimes feel this? It seems as if there is a tissue/fluid build up and if I spend the effort pushing it all away I can finally find it and then others can come along and easily confirm it. An hour later it is all gone and it is then difficult to locate (making me look silly when I say it is obvious). Does fluid build up in these areas or something? I really need a doctor's confirmation so that I can put an end to this perpetual hell. I'm afraid that my next doctor visit will be another unsuccessful attempt to locate this obvious problem that has gone undetected by 3 MRIs.

Sorry about the emotionalism. Why am I apologising to a text box? Send

[dibblego]

Here is my story: Ankle Injury - Tony Morris

Comments are appreciated. Please help.

[Julesel]

I am sorry about your luck. I actually had the Brostrom-Gould Procedure done about two weeks ago. Before I had the procedure, I had sharp pains that went up my leg and the pain and the intervals between pain and relief kept getting worse. I had an MRI done in April and it just showed the ruptured ligaments that needed repaired. It did not show what the surgeon found inside my ankle. When the Orthopedic surgeon cut me open, he found that a tendon had broken off a piece of my fibula and it was still attached to the tendon. This piece of bone started to calcify and was creating a pearl inside my joint capsule. This was most likely the cause of my horrible pain and strange swelling. This swelling would come and go and would get worse as the day progressed. Anyway...the point of my story is that MRI's do not always show everything and sometimes the doctor has to cut you open before he can find out what is wrong. Maybe some sort of scope or biopsy would be a good idea in your case. Good luck