Given three weeks, is this wishful thinking?

Hi,
Here's my story, in full so you get all the details, - 5 weeks ago i jumped up and landed full weight on the lateral edge of my foot. I heard a snap but it did not hurt too badly so I just went home and applied the RICE principles. The next day I was fully non-weight bearing. After a trip to the ER and a set of x-rays, I was told that the swelling was too severe for sonar and was sent home with a moonboot, crutches and a followup appointment the next week. At the follow up I was sent for a joint stress test (no warning could have prepared me for such pain) and then a sonar. After the tests I was referred without explanation to an orthopaedic surgeon. He told me that the stress test showed that the ankle joint was opening 15 degrees further than it should and according to the sonar I have a grade 3 sprain of my ATFL and a grade 2 sprain of my CFL with tenosynosivitis of the mm. peronei. He also did an anterior drawer test which showed gross instability of my ankle. The surgeon sent me home with the moonboot and told me to treat it like a cast for 4 weeks then follow up with him.

Yesterday I saw the good doctor. He redid the drawer test and said that it appears as though I have regained stability (good news). Problem is, the ankle is still swollen, painful at the slightest bump/movement and I have lost most of my range of motion. The surgeon referred me to a physio and said that I have three weeks to regain full functionality. That is no limp, no pain and full motion. If I'm not at 100% in 3 weeks then I must return to the surgeon and we will have to do surgery.

So I went to the physio and told her the ultimatum the doctor gave me. She looked anything but hopeful and after viewing my file said that she was surprised that I did not have surgery in the first place. We had a full session anyways - dorsiflexion, plantarflexion, lateral eversion, toe lifts, balance and calf stretches - and I'm booked for another session tomorrow.

So after that long diatribe, what I would like to know is your opinions? What are the chances of full functionality in 3 weeks? Should I just call the surgeon and ask to consider surgery now? Or should the physiotherapy be given a longer time to be effective?

Thank you for your time

Ok, so I had my second appointment on friday. Improved dorsiflexion but still very limited plantar flexion, which according to my physio in unusual considering the injury. We did more balance work, ultrasound and laser therapy to assist with the ROM issue and dry needling in three trigger spots in my calf. Physio also mentioned that I seem to have developed some plantar fasciatis and some mild tendonopathies of the mm. peronei and now also my achilles. Down to walking with one crutch and bearing +-75% body weight. Cannot do stairs yet though. I also seem to be shifting too much weight to the outer, lateral edge of my foot compared to my 'normal' leg.
So with the new/progressed info, any opinions? We're down to two weeks from the initial ultimatum given by my surgeon. I still don't know what to think/do. Physio said patience but again is very concerned regarding the limits to my plantar flexion.

Hello,

I doubt you'd be 100% in three weeks. Curious as to why the surgeon would proceed with surgery if your ankle is no longer unstable? Does he perceive that something else may be going on in the ankle? What did your physio find when she tested for stability?

Thats what I thought. I understand that human medicine is different from animals but 3 weeks just seemed a tad too optimistic. In terms of stability tests all that seems to have been done is the surgeon did a quick anterior drawer test then pawned me off to the physios. The physios checked ROM and started me on stability, ROM and balance exercises. Since then no one has mentioned stability or prognosis again. Todays session consisted of laser therapy, some massage to try increase the plantar fexion (still extremely limited) and some balance/proprioception exercises.

Maybe the surgeon is concerned that if I havn't improved to adequate walking in (now 1.5 weeks) that there may be osteochondral defects? I did raise concern over developing DJD or OCD... And I am time limited, next year I start working in the hospital - which leaves me on my feet all day with no chance of taking the 6 weeks required for surgery and rehab.

I still don't want to rush into unnecessary procedures. In your online opinion (making it limited, I know), if I stuck with physio past the 3 week mark, should my ankle regain full ROM and functionality?

Thank you so much for replying viola, I appreciate it.

Oh and just a quick question - is it normal for your foot (in particular my toes) to experiance a numb tingly - like pins and needles - sensation when getting laser therapy?

I'm not quite sure because I don't know what your surgeon's insights and thought processes are on this one. Sorry! It is difficult over the net, for sure.

With the tingling into the feet with laser, I'd check in with your PTs and let them know that's happening. I've had little experience with laser, so am not versed on the side effects or effects.

Thanks for getting back so quickly :). I'm not too concerned about the tingles just thought it was wierd as the first two times I didn't feel a thing, probably find the swelling/scar tissue is diminishing so the laser is getting deeper contact.

I think I'm just gonna keep soldiering on with the PT and see what happens at the end of the initial ultimatum. Kinda sucks having a vague understanding of what's happening but not full knowledge cause our fields are not interchangeable - but I suppose that's why vets/docs make some of the worst patients ;)

Haha, you can add physios to that bad patient list too!

I think there would be a lot of similarities between the fields.

I think you should discuss with your surgeon when you see him. He may change his mind if you've made a certain amount of progress. And if you're feeling like the PT is the best way to go, discuss this with the surgeon as well.

Wishing speedy healing to you.