Ankle Sprain - worsening after 6-7 months

[SkyBlueCity]

Hi All,

Wondering if anyone can offer any advice or experience please?

I sprained my ankle before Christmas by rolling it on even ground. I heard a snapping at the time and had severe pain my husband was several steps in front at the time and commented on the noise. He helped me hobble home, it wasn't far.

I immediately elevated, iced and rested. After it was still incredibly painful and swollen I went to a&e for an x-ray about 5 days later. They said it was fine, just a bad sprain. There didn't appear to be too much bruising.

For about 6 weeks I avoided any impact activity, continued ice, elevation etc, then slowly returned to some light running based on the a&e advice.

After a few weeks I was still experiencing a lot of pain so stopped running and any high impact activity.

I went to see a specialist chiropractor who said my ankle was completely jammed up and used ultrasound therapy and an 'activator' tool to pop bones back in to place.

I went for several of these sessions, perhaps 7 or 8 over the same about of weeks but no improvement. I then went to my GP physio who questioned the chiropractor treatment, and said I needed to do strengthening activities as have barely any stability in my ankle.

6 weeks later and I am still in so much pain, particularly on at the bottom of the bony part on the inside of my right ankle. It is so sore to touch. It causes me to limp a lot as it hurts too much to put weight on. There is also still a fair bit of swelling.

The GP physio has now put me on anti inflammatories, advised to continue strengthening exercises, ice, elevation. I had an ultrasound last week but was told 'oh, we can't see ligaments on an ultrasound so you'll need an MRI scan'. They did say that my tendons look OK but a tad inflamed, and I have fluid on the ankle.

I have also now started experiencing pins and needles / numbness in my foot and toes, and the sensation of an elastic band tied round my ankle. The GP said this is nerve compression and has prescribed Amitryptaline and referred me for an MRI.

I'm so upset by the treatment that could have been completely wrong for me, but also can't believe how sore it is and how much worse it is getting. I tore ligaments in both ankles about 20 years ago falling down some stairs, so I definitely have weakness there but this pain is so frustrating.

Has anyone else had a similar experience with a sprain? Could it be ligament tear??

Many thanks and kind regards

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[Awhina]

Hi,
so sorry to hear your story. You must be in agony.

As ankle sprains have a tendency to self-heal reasonably quickly, the first treatment (ice/ elevation/ compression/ pain management/ gradual loading) is as per guideline.
We expect a healing time of about 3 weeks for mild sprains without any further intervention. This can sometimes take a little longer (moderate sprains), as the simple first exams like Ultrasound only give an estimated evaluation of the severity.
If this does not happen, the injury is likely considered 'severe' and further investigations need to occur. Recovery of severe ankle sprains can easily take 3+ months.
Not sure whether your GP was consulted at that stage, but commonly, you are sent straight away for an MRI or to a physio/ osteo/ chiro/ podiatr. Please rest assured that your bones must have already been in the right place. Had they 'popped out', you would not have been able to put any weight an that ankle.
It was worth a trial but obviously, the next 8 weeks of Chiro did not further your healing, nor did the 6 weeks of physio.
You then had a second US - what was the result in comparison to the first one?

Your current management plan is to undergo an MRI and I presume, you will then be sent to a Specialist Orthopaedic Surgeon for a consultation.

There is no point in discussing who was wrong or who was right or whether you were in the correct injury management plan from the start. There are still many variables in ankle sprain healing and we cannot predict all of them. Important in your case is that many avenues were explored, that we now know that your sprain appears to be more severe than initially expected, and that you have been referred for further investigations.

I recommend for you to wait for the MRI results and the Orthopaedic consult. They will explain what is going on and re-define your management plan.
In the meantime, you could also discuss with your physio whether they believe an ankle splint (referral to Podiatry?) might help with your pain, esp. when you walk long distances.

While remote case discussions are always difficult, it would be interesting for all here to follow your case. if you could let us know how your recovery progresses, this would be greatly appreciated.

All the best,
Awhina

[Emmamaaz]

There are so many methods in physiotherapy to reduce the pain. If it persist after the therapy section tou must consult an expert doctor to resolve the same.

[mmwr715]

Sounds like impingement of cartilage between the medial malleolus and the medial facet of the talus. - a piece of cartilage tear stuck there. Might show on MRI and needs debridement surgery though I have tried cortisone injection into spot...

Van Dijk, C. N., P. M. M. Bossuyt, and R. K. Marti. "Medial ankle pain after lateral ligament rupture." The Journal of bone and joint surgery. British volume 78.4 (1996): 562-567.
Bone & Joint


You need to see an orthopedic surgeon that specializes in ankles.

[CMH123]

That's true. There are so many methods in Physiotherapy to reduce the pain

[SkyBlueCity]

Thanks so much for the replies and opinions.

I've had a read through the information on the Medial ankle pain after lateral ligament rupture document, thank you mmrw715. That sounds amazingly accurate! There is such a pain point on the medial malleolus to touch. And every so often (doesn't matter what I'm doing at the time) I get a really sharp stinging pinching pain which feels like it comes from behind/underneath where the medial malleolus sits, like something is caught.

My MRI is on 28th September so not too much longer to wait in the grand scheme of things.

I will keep you posted on the progress and feedback from MRI.

[SkyBlueCity]

Hi all,

Update on my ankle. The symptoms are still no better unfortunately, and I have now had my MRI scan (earlier than originally planned), and have a copy of the results.

The key points noted at the end are:

1. Focal chondropathy with subchondral microcystic changes to the posterior medial dome/posterior talar process

2. Small volume fluid concerning for mild tenosynovitis along the tibialis posterior and flexor hallucis longus tendon sheath

3. Mild to moderate subacute sprain of lateral ankle ligament complex.


Elsewhere in the report it says focal subchondral microcystic changes at the posterior medial and posterior aspect of the talar dome concerning for occult high-grade overlying chondral fissure.


Can anyone help with what this actually means please?

My physio has said there's nothing to be concerned about, just lots of sprained ligaments and tendons but is referring me to orthopaedics at the hospital.


Thank you so much for any advice!