long story short… sprained my ankle 7 weeks ago, still in quite a lot of pain.
More details:
fell trail running, went to ER, no break, told I had a “bad sprain” as I couldn’t walk.
Followed up with local podiatrist, sent for an MRI
MRI report showed partial tear deep deltoid, partial tear quadratus plantae, and a medium size OS trigonum which could lead to a posterior impingement
however, none of the above fit my symptoms.
I was on crutches for 2.5 weeks, then in a walking boot for a week, and then walking with high arched insoles for support…
Been doing physio religiously 2x per week.
Symptoms:
My arch is visibly “flatter.” I wouldn’t say it’s completely flat, but it is definitely flatter then the other foot. It feels like and looks a little like my ankle is falling inwards which is causing the flattness.
Ankle was uncomfortable during the day, and hurt worse at night. Then a couple days ago I stepped funny walking to work (stepped up a curb with the weight more towards my toes), took my breath away and have suffered through a couple days of fairly intense pain.
Pain is in the front, more to the medial side, but I do get pain basically in the entire joint.
Dorsiflexion causes the most pain in the joint.
It almost feels like something is just a little bit out of place.
My chiropractor thought she could help and she tried adjusting it, but then I wound up in more pain for 2 days.
Could something have been missed by the radiologist? Does anything fit with the issue’s i’m having?
I’m pretty tough, If there was any way for me to be doing any sort of training I’d be doing it! Running is absolutely out, I can walk but anything over a mile and I get pretty sore. Swimming is sore because of kicking. I have tried biking on my trainer, but the clip in pedals make my ankle hurt after about 5 minutes, but I have been able to suffer through 15 minutes, with little to no resistance. The most frustrating is that I don’t even really know what is wrong with it, so I have no idea the game plan is to get back to training…which is driving me crazy. And so i in turn drive my husband crazy. It’s been 7 weeks.
Help!.. before he divorces me! lol just kidding… but really.
Your deep deltoid and quadratus plantae issues on MRI are very atypical with an “ankle sprain” (which is typically an inversion type and lateral issues - not medial).
Your description is of spring ligament/distal PT tendon issues and needs to be addressed. I’ll assume a good musculoskeletal radiologist read your initial MRI (or those specifics would not likely have been mentioned at all). I’d rec returning to who saw you last and relate the same story and go from there. Usually takes some argument by your treating physician, but a repeat MRI might be in order.
I sprained my ankle 10 weeks ago. It was all kinds of ugly and hurt to walk. Had I gone see an Ortho, I’d probably have been in a boot for 4-6 weeks, but I’m a bit stubborn.
Anyways for myself, yes it hurt sliding my foot in my cycling shoes the first week (didn’t even think about clipping/unclipping as that motion hurt), but once my foot was in, I could tighten down the shoe some and ride with zero pain (this kept me from going crazy). I cut out my hard intervals and just focused on Tempo/SST efforts everyday. Do not try to kick in the pool, just pull. Kicking will just hurt as it causes your ankle to flex. It took about 8 weeks before I even tried kicking in the pool, and even then, my ankle gets sore after awhile. I didn’t plan on running until January, but the bug hit me at 8 weeks, and so now I run once a week. Ankle still gets a little sore, but pain in the joint while pointing my foot is basically gone now. I still lack some flexibility, but it’s getting closer to normal each week.
How often do you ice? I ended up getting some 110% Play harder overdrive compression socks with ice sleeve to help with it. Expensive, but trying to get an ice bag on the right spot and wrapped was a chore. If at 7 weeks your ankle is getting sore from just walking, I highly recommend getting it re-examined.
Thanks dr. rroof!, I’ll take that information with me when I go back to the doctor. I’m headed back this week, since that weird step has caused some pretty significant pain. In fact my husband was ready to take me back to the hospital, I don’t think he’s ever seen me like this before, he agreed to just let me follow up with my doctor.
geauxtri, yeah I have no ability to unclip my pedals, and sliding my foot in is definitely tender, but after a few minutes it starts to ache in the ankle itself. The pull buoy for swimming is worth a try, for something to do!.. although swim training is my least favorite part of tri training and so it’s hard to convince myself to head to the pool. I actually have an air cast ice boot (http://www.physioroom.com/product/Aircast_Ankle_Cryo_Cuff_with_Cooler/2272/35981.html) on loan from my mom which has been a savior.
I feel fortunate my ankle didn’t bother me cycling. I may have gone crazy, as swimming is not my favorite activity. Pulling, while practical, gets old real quick. We just got a new coach, so hopefully I can take some of this down time in swimming and work on my technique while getting back to the point I can swim and kick without my ankle getting sore. I did more breast stroke swimming as my ankle improved as I could kick there without pain.
Dr Rroof, if you see this I need help!
I went to follow up with my doctor. He admitted he has never ever seen a spring ligament tear and wouldn’t even know what to do for it. He’s not even really familiar with symptoms of a tear, the anatomy or it, or how to treat it… but didn’t want to look at the document you sent me.
He recognized my ankle is pronating and my foot is flatter (not completely flat, but certainly flatter). He found it weird I could still do a heel raise, but that’s because my PTT is funcioning still.
He is going to try and get the MRI reread, but that is a long shot without getting a whole new one. Aparently the company I got the MRI with just has 3 general radiologists, no muskuloskeletal radiologists, and he never uses them.
His only recommendation int he mean time is to go back in my cam boot, and on crutches. Follow up with him in 2 weeks, and in the mean time hopefully he can get the MRI re-read.
What would you recommend?.. I wish I lived in Cincinati I would just come see you.
Hmmm … the spring ligament is really just an extension/part of the deep deltoid (and some believe some slips of the distal PT tendon). If your foot is noticeably “flatter” then the other yet without loss of strength (your single leg raise test) or distal PT tendon issues on MRI, the spring ligament has to at least be attenuated. A nasty injury for sure and somewhat uncommon/misdiagnosed.
Since a general radiologist read the deep deltoid tear, I would bet a good musculoskeletal guy would “call it” a spring ligament tear. It is possible that it can heal with immobilization depending on severity, though they often don’t. Attempts at surgical repair are complicated and rare for even experienced surgeons. A repeat MRI after a couple of weeks in the boot at least (maybe even a cast), read by a good musculoskeletal radiologist (can send out even, I prefer Dr. Steve Pomeranz or Dr. Richard Rolfes who literally wrote the book on MRI of the foot and ankle). Dr. Pomeranz (or others) are licensed in all 50 states and a few countries and reads MRIs from all over the world, so you might have some luck with your local physican being able to get a read from him since this can be done electronically in most cases (“teleradiology”).
Update:
They had my MRI re-read by a musculoskeletal radiologist here in Calgary. He read 2nd degree sprain in Inferior and Superomedial spring ligament complex, deep deltoid tear, and 2nd degree sprain in ATFL.
My Sports Medicine doc admitted he has never seen anything like this before.
My arch when weight bearing is measuring 1/3 of the height of the other ankle, my ankle is pronating inwards, and I have no heel movement when I go up on my toes, however, I still have the ability to do a single leg heel raise.
It has now been 11 weeks since my injury. The sports medicine doc said he wants to do the conservative approach (which I’m pretty sure I’ve been doing now for 11 weeks). He wants me to stay in a boot for another month! (which will include my trip to mexico next week) and will bring me to 15 weeks post injury. Does this sound reasonable? When would surgical intervention become an option? Also he tried to convince me to stop doing Ironman’s and marathons… haha, yeah right.
Beyond frustrated, and desperately missing running, biking, hockey, and skiing!
Though I had an entirely different injury, one thing I learned is ankles are tricky as hell.
I went through a period of about 9 months of pain in which I could very minimally train, but not very much. I had a doctor that kept telling me to immobilize and rehab. I would do this as presribed for periods up to a month with zero success. Imaging didn’t show much of anything to the first doc. I finally went to a foot and ankle ortho and he didn’t see much more in the MRI, but said based on the pain he recommended an arthroscopic procedure, there was probably some impingement that he could clean up. We scheduled and when he opened me up found a decent size ocd along with impingment and opted to treat with the ocd with microfracture right then and there. That decision took the recovery time from 4-6 weeks to a little over a year and counting, but I am finally running a little more and pain is much less regular.
Point of this story is what I learned about ankles is they can just be very unpredictable. I have gone through periods in the last year where I strongly questioned if I should have had the surgery. I think I am finally getting to a point of believing I made the correct decision 18 months after the surgery, 2 years after the last sprain that brought this to a head.
Update:
15 weeks post injury… still cannot walk in the boot without pain. Went to the sports doc, he agreed conservative measures aren’t working. Headed to a surgeon, however, who knows how long it will take to get in in Canada. He’s making some calls to make sure I see a surgeon who has dealt with an injury like this before, and he’s going to try and push to get me in ASAP, but the ankle surgery que is pushing a year. On crutches and in the boot for the forseeable future…
Goodbye marathon in May, Goodbye ironman Mont tremblant. I’ll get to go cheer on my husband… at least he’ll finally catch up to my number of ironman finished now.
On the bright side, the crutches didn’t keep me down on my fantastic trip to mexico.
Having a rough time. Got out of my boot and crutches 2 months ago. Still unable to walk more than 20 minutes without significant pain. On my bike I removed my clip in pedals, with flat pedals and straps, and yet I can barely get my heart rate up without significant pain.
Surgeon did an ultrasound to see what the ankle looks like right now.
Spring ligament partially torn (at least it’s not totally gone)
Flexor Hallicus longus tendinopothy (he thinks this was an acute injury from when I fell)
The Surgoen also looked at my ankle, and agreed that I have pretty severe subtalar joint laxity.
He is hesitant to do surgery right now, and is recommending a cortisone injection into the FHL tendon, a prolothereapy injection into the spring ligament, and a lidocaine injection into my subtalor joint, and then follow up with him 3-4 weeks after the injections.
Since he/she is the only one to have actually examined you, the thoughts are to go with the recommendations (since seeing another specialist for a second opinion in Canada is quite difficult I’m told)
Having said that, having all that done at once doesn’t make much sense: the lidocaine inj into the subtalar joint is simply for diagnostic purposes and there is very limited data for ‘prolotherapy’ into anything, let along trying to hit the Spring ligament (I assume an ultrasound guided injection). A corticosteroid inj of the FHL tendon might be helpful though!
