Baffling 10 month ankle sprain

[karen.hankey]

Hi Sam,

Have you considered Tibialis Posterior dysfunction. I had a football player who suffered a kick onto the inside of his ankle. He was treated for medial ligament sprain but did not improve over a number of weeks. As a student at the time I researched to discover any other possibilities and discovered tibialis posterior dysfunction. I strapped his foot and he was able to play with no symptoms and gradually he was weaned off the tape and returned to normal play.

Tibialis posterior is involved in maintaining the arch of your foot. With a kick to it, even though you don't tear the muscle, you effectively stop it from working properly. Due to this you then start to pronate more (loose the natural arch in your foot) which in turn stretches the tendon which stops it working properly - so in a big cycle!. The aching is a sign that the muscle is trying to work to hard to maintain the arch but isn't strong enough to do so. This becomes more noticeable with quicker, unexpected movements.

The initial thing to try with it is a taping technique called "low-dye taping" which will support the arch of your foot and therefore take pressure off the muscle and should help with the aching. There are exercises that you can complete, but as you've had this for so long, they may not be effective. So due to this, if the taping technique works, then an insole would be the best thing to go for - however, I would get one custom made if possible. Before that, ensure that your shoes are supportive - ideally a trainer with a good arch support is best, rather than a smart/dress shoe. Also try not to walk around at home with no shoes on, especially if you have hard floors

Hope this is some help to you.

[sammo440]

Thanks a lot for your thoughts. I'm certain it's not gout as the swelling has been light for many months now, to the point that it is only possible to know that it is swollen when comparing it with the other ankle iunless I've done a lot on it that day. The swelling is also over the exact part of the ankle which I sprained (which I'm now pretty certain is the anterior talofibular calcaneo fibular ligament) and I can't really see any indicators that it might be gout (I have a healthy lifestyle etc).

I'm fairly certain that this is just a chronic ankle sprain, and whilst I have been trying to be careful, I think it's just so sensitive to any stress whatsoever, that I'm doing something without realising that has caused it to get stuck, so that it aches a bit most of the time and more so whenever I walk on it for more than a few minutes. I think this because it seemed like a regulation ankle sprain at first (and not even a major grade 2 one), got better fairly quickly, got stuck a bit just before it was fully recovered, took longer when it was re-injured, and now again is taking longer still after it was re-injured 3 months ago. Maybe if I describe how I've been using it day to day it might give some clues as to what I do differently

To get to work, I cycle to the train station where I have to take my bike up a largeish set of stairs to take on the train with me. I then have to carry it down the stairs at the other end, then do the same again at the next train station. I take my bike with my because it saves me having to walk the 5 minutes between the 2 train stations and the 10 minutes from the 2nd train station to my office.

At work I keep my foot up on a chair, and for the last few weeks have been icing it regularly throughout the day. If I am in a meeting and cannot keep my leg up then up until a couple of days ago I have been extending my leg out a bit and my heel only on the floor as this seems more comfortable, but my physio just told me that this extends the ligament so I shouldn't do it. I had it in my mind that it was less comfortable to sit normally with my feet flat as it felt like there was more pressure going through my ankle, but I guess I might be wrong in this, and certainly when I sat with my foot stretched for 2 hours the other day my whole foot seemed to be aching afterwards.

I do the same journey from work to home afterwards and then I basically keep my foot up again as much as possible whilst walking around a bit to cook etc. I am also now mindful of the fact that sometimes when I sit with my leg up, the ankle is again a bit stretched, so I am now trying to rest it up but with my foot against something to keep it at a right angle to my leg.

The only other thing I do during the day is stretch my calf and hamstrings, and sometimes massage the front of my calf as this seems to give some temporary relief to my aching ankle, although the relief it gives lasts shorter amounts of time throughout the day, going from maybe 40 minutes to 5 minutes. I only feel tightness ever in the front of my calf rather than the back, but stretching either seems to give some relief.

As for the tightness I feel in the bottom of my foot and around the arch, from looking it up, tibialis posterior dysfunction seems unlikely. When I had a similarly chronic knee injury which finally ended about a year ago, my physio looked at my biomechanics and noticed that my feet rolled in a lot naturally so I made efforts to correct this, but probably relied too much on my toe flexors to support my arch rather than gain the required strength in my glutes by building them up. When I then injured my ankle I think that this put even more pressure on the toe flexors to provide stability and support in my feet and so they are very prone to tightness. I am slowly getting there with building up my glutes and using my core muscles more to improve my posture but this obviously takes time to correct the mistakes I had developed over my first 26 years and then the new "quick fix" ones I developed over the followig 2.

I do have a tendency to go on a bit on these posts don't I. Does anyone even read this far?! Thank you a lot for anyone who has done, and thanks again to Karen and Podiatry for your thoughts.

[sammo440]

Oh yeah, an extra bit of relevant information: before any of this happened, I was told that I have lax ankle ligaments. Also, with all the changes I've been trying to make to my posture I think instability in my ankle might be something to do with what's going on. I have seen a podiatrist about my feet pronating in the past, but they just gave me insoles. I feel like now I'm this far in, I want to sort everything out properly rather than just go for a quick fix like that, although my priority is first to get my ankle sorted, so again I'm not really sure what to do!!

Finally, any recommendations for physiotherapists who have a specifically strong awareness of chronic ankle sprains in London, please let me know.