Ankle pain made worse by physio

A few months ago I started with a pain on the outside of my right ankle just below my ankle bone. I don't know what caused it, it just started hurting as I was cooking in my kitchen one lunchtime. A few weeks later I was seen by an NHS physio who said I'm sprained a ligament in my ankle. There was still slight swelling in the area and it was giving me occasional pain. He gave me a set of stretching exercises to do (standing facing a counter top and leaning in towards it to stretch the muscle in my back of my ankles, feet turned in, turned out and forwards, hold for 30 seconds, 8 reps of each position) and told me to ice my ankle for 25 minutes 5 times a day.

I had difficulty doing the exercises (I have suffered with ME/CFS and Reactive Arthritis for the past 20 years) but I gave it my best shot. I had the most trouble with the ice though. I used a bag of frozen peas wrapped in a hand towel. After 25 minutes my foot was very cold and a few minutes later I had a very sharp pain going through my ankle as if someone had hammered a red hot nail through it under my ankle bone. The pain lasted about 30 seconds and was 8/10 on the pain scale, I had to breathe through the pain and it actually brought a tear to my eye. Gradually the pain eased off but it was still sore for an hour afterwards.

This happened several times after my ankle being on ice so I telephoned the physio. He said I must carry on with the ice and the exercises if I wanted to heal my ankle. I explained that I couldn't do that because it was making things worse and he coudln't offer me any other advice because the ice and exercises should not have caused the pain.

I still suffer the odd twinge from my ankle and it occasionally swells up. Does anyone have any idea why the pain got worse after treatment? Is there anything else I could try?

Thank you!

Clair

You could have some reflexive pain after icing as the blood flow returns to the area. I would however not ice for more than 10 minutes at a time. You can then let the ankle return to body temperature after which you can repeat for another 10 mins. 5 times a day is a little excessive in light of the fact that you cannot remember injuring it.

There are other things that could cause lateral ankle pain: referred nerve pain, local inflammatory conditions in the joint etc. If you are in persistent pain then perhaps another review (maybe with another therapist) might assist to consider an alternate diagnosis. Sometimes a clinical assessment indicates one probably cause but subsequent treatment suggests perhaps it is something else. All part of a normal process of elimination.

If all that fails you could scan the ankle to see if that shows anything further. But mostly that should not be necessary. Do let us know how you get on.

Hi there - this sounds most definitely like an irritation to your peroneal nerve as it passes under the lateral (outside) of the the ankle. Why it is inflamed may well be due to either a flare up of the arthritis and/or an adhesion to the nerve a it passes through a bony canal. If this sounds right to you, let me know and I can tell you how to test further and work on a cure...

Thank you for your replies. I'm afraid the problem has flared up again. It seems to get worse when I spend time working in the kitchen in bare feet or wearing slippers. I have a complicated medical history and it's probably part of a much bigger problem. I tried ice for 10 minutes but it caused the pain to get worse again, almost like something was suddenly tightening deep in my ankle.

My rheumatologist said I was borderline hypermobile, my joints were at the bendy end of normal and despite being overweight and unfit I can easily touch my toes, something that no-one else in my family can do. I wonder if when I side step in my kitchen and I'm not wearing shoes I could be going over on my ankle slightly and not even realising.

Thanks again for your advice.