Ankle Injury - Should I get another opinion?

[paige4444]

Alright, so about 6 months ago, I had sprained my ankle while doing plyo lunges (kind of like a jumping lunge) at a bootcamp class I take regularly at the gym. I have dealt with injury before so I followed the typical RICE treatment, switched to low impact activities, and let it heal. It was definitely painful, but after a few weeks the pain had mostly subsided. After I began doing higher impact activities, I would feel a great deal of pain while I worked out and right after I worked out. As time went on, I would continue to feel pain doing my day to day activities, even just walking around. I began to get concerned, so I focused on reducing the amount of activity I did and got advice from a trainer at the gym to do some physical therapy exercise. After a month, I had felt little to no relief and my ankle was constantly in pain, especially at night.

I decided to make an appointment with a foot and ankle specialist the other week. I went in, answered the typical questions, got X-Rays and an ultrasound done. Because I had basically not been able to walk around the few days before my appointment, the swelling bruising had gone down. My pain is located directly on my lateral malleolus and anterior and inferior to it. I also have a great deal of pain over my talus, especially when it was touched (right where my foot and ankle meet right past my fibula, if that makes any sense). My ankle grinds, cracks, and pops a lot where the pain is over my talus. I also experience a locking and catching feeling at times.

So the doctor said that he couldn't anything very conclusive on the x-ray and ultrasound, but later he showed me that the end of my talus was chipped off (I think it was the lateral process, but I may be wrong). He also seemed concerned about my anterior talofibular ligament. He had me make an appointment for two month later and said that if the pain was persistent he thinks it is chronic ankle pain (which is frightening considering I am relatively young) and would consider doing lateral ankle stabilization surgery. He also told me to only do low impact exercises and wear and ankle brace to remind myself to 'baby it'.

I am curious as to what others think about this. A week after that appointment and I am still struggling walking around my house without being in a great deal of pain and discomfort. I am awfully surprised with the fact that he didn't order further imaging due to his inconclusive findings. Would it be worth getting a second opinion? I don't want to waste time and money, but I am very concerned about this pain.

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[tonywoodall]

Hi ? Ankle Sprain,

An interesting collection of history.

Starting at the beginning. When you lunge strongly you may cause injury to any of the components of the legs from the lower back to the hips, to the ankles and feet.

Two clues - an X Ray shows a chip off the Talus and the location of your symptoms vary from the Lateral Malleolus area and the Talus. I wonder if you have any other symptoms in the same leg and lower back, Hamstrings, Calf and other parts of the Foot.
If not then your problems are likely to be caused by the bone chip and possibly resultant inflammation of the Tendons and Ligaments in the area. The grinding, cracking, popping, locking and catching would be from problems in or about the tendons.

A CT Scan would be able to detect all Bone related problems and possibly Tendon problems. If the cause is the Bone Chip then a trip to an Orthopedic Surgeon is first on the list and then follow his advice, possibly excision of the chip. The related soft tissue symptoms won't subside completely until the cause has been fixed. Unfortunately minimal weight bearing is vital for a fix.
Good luck,
Tony Woodall. Physiotherapist - Retired.