Podiatry/ortho advice on torn ankle ligaments

Triathlon Forum
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First, I am currently waiting for an ortho foot/ankle appt, but that could be 2 weeks. I am looking for advice on what i should not do (I have a tendency to push to much to get beck into things) as well as educate myself on what to expect. FYI 5’10, 170, 41 yo. i did use Five fingers to run on grass 1-2 (rarely) times a week (interval stuff–mostly fast running trying to stay loose). the rest of my running is flat roads
on August 25 i was doing a trail run with a friend while on leave (military-speak for vacation). I rolled my left ankle, inversion, went down hard, hurt a lot, but decided i could run on it–I now regret that as we had about 3-4 miles to get back to his house. x-ray 2 days later (lots of swelling bruising and pain so i went to the local ER) was told it was a mild-mod sprain and x-rays were okay. Did RICE and wore an air splint about 10 days (started easy riding about day 7), then decided it still hurt so went in for an x-ray–nothing but small avulsion fracture. I switched to an ASO ankle wrap, continued riding, did ankle range of motion exercises, balance on one foot, etc. I did continue to do free weights with some squats (max 185-200lbs). After 33 days it didn’t hurt to touch the ATFL area, so i went for a run–this was Sep 30. it felt odd/stiff, and it almost felt like there was still range of motion limitation, but i thought it might loosen up–went 4 miles, hurt but not horribly. after the run, and into the next day it hurt more–and more deep in the joint and medial aspect–especially at limits of either plantar or dorsiflexion, and some mild swelling returned. On 1 Oct. I got an MRI which showed: complete ATFL tear, partial CFL tear, tear of deep deltoid fibers (superficial intact), medial aspect of talus bone marrow edema, kager fat pad edema, and posterial tibilial tenosynovitis.
So—a few questions:

  1. the MRI was just over 5 weeks out–could i be that slow to heal, or did my weigths and running prevent healing or re-injure the torn ligament?
  2. i looked on PUBMED, but can’t find much on running. what i read seemed to indicate conservative treatment works in 80%–but i quailified for Boston so want to do that this April–is that reasonable?
  3. should i be asking about prolotherapy or platelet enriched plasma to help the ligaments heal better/faster?
    I really don’t want to think about not being able to run as i did before
    thanks for any advice or experiences
    jim
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  1. the MRI was just over 5 weeks out–could i be that slow to heal, or did my weigths and running prevent healing or re-injure the torn ligament?

The thought of doing balancing exercises and squats with a sprain makes me cringe. A torn ligament is not like a muscle where you can do easy exercises to help it heal, you need complete isolation.

  1. i looked on PUBMED, but can’t find much on running. what i read seemed to indicate conservative treatment works in 80%–but i quailified for Boston so want to do that this April–is that reasonable?

Depends on what your goals are. If it is just to finish i don’t see why not. If it is for a PB it depends on your recovery.

  1. should i be asking about prolotherapy or platelet enriched plasma to help the ligaments heal better/faster?
    I really don’t want to think about not being able to run as i did before
    thanks for any advice or experiences

It is not covered by insurance from what I hear so if you want to pay cash for it then that is up to you.

jim

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Thanks for that reply. While i confess to being a typical push through the pain kind of guy, i would NOT have done exercises, weights etc, if i had not been told by the initial ER it was not a grade III sprain. when i got the MRI result I was really upset–mainly at myself for possibly making it much worse, and then mad that i didn’t know sooner to protect it properly. Oh well, i was able to balance and do squats without any real additional pain–the swelling took a long time to go away (just over 4 weeks), and whatever i felt i when squatting I thougth was just fluid in the joint causing a mechanical compression or limitation.

I just want to know what to do now so it will heal. I am guessing 8-10 more weeks, but don’t knwo if a certain protion of that needs to be with almost no ROM (ie cam boot) so the torn ligament can approximate and heal???
thanks
jim

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I had a lot of ankle issues when I was younger and they still pop up if I do squats to this day. Not sure how much time you will need to take off, probably have to play it by ear. 4 weeks for swelling seems like a lot to me. I guess I don’t really have an answer for you. Less use is better, but you also don’t want to lose fitness. It is a tough balance :slight_smile:

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