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Ankle Sprain gone bad!!

by Nick
(Tucson, AZ)

Freshly injured lateral ankle sprain

Freshly injured lateral ankle sprain

Freshly injured lateral ankle sprain
Freshly injured inversion sprain
four weeks after lateral ankle sprain

Hello,

Exactly one month ago I went to the basketball gym late and didn't have time to stretch or warm up before a group of guys asked me to join in. I jumped for a rebound in the game and came down on my foot and it inverted, but my foot was still a little plantarflexed as it inverted. So it was a slightly plantarflexed ankle inversion. I collapsed immediately and could not stand. The pain was pretty severe and my ankle swelled up immediately. Especially along the lining of where my Talofibular Ligament is.My ankle bruised up the next morning, and even along my shin up my leg. I have sprained my ankle once before in the same foot in the past, and that healed in about two weeks. I assumed this was the same thing, but on a higher pain scale. I was taken home and wrapped my leg in an ace bandage, elevated it and iced it. For four days I stayed in my bed with my ankle rested following the R.I.C.E. standard. My ankle didn't seem to be healing very quickly so I took a new approach. I began doing H.E.M. therapy. It consisted of Hydrotherapy (Alternating cold and hot water to get the blood pumping), Massaging the swelling out, and doing ankle pumps to regain a little range of motion and pump nutrients into my foot. I did this twice a day. My swelling started going down but the pain was still pretty bad. I do not have money to go to the doctor so was hopeful this would help. My Manager was wanting me to get back to work and I couldn't walk, so I decided to order a cam-walker. (I figured if it was a level 2 or 3 ankle sprain that the doctor would give me this anyways) I tried walking in it but the pain shot up my shin area and also affected my peroneus brevis tendon area. I then stopped walking on it and used crutches at all times with the boot. It turns out I ordered a small Cam-Walker on accident instead of a Medium. I needed a size 10 and this was for size 7. I decided to wear it anyways. For 2 weeks I wore the boot at nearly all times unless I was doing my H.E.M. Therapy. I noticed a lot of my bruising and swelling disapeared, but pain was still occurring. I then decided to do away with the boot, and try letting my foot breathe. It has now been almost 5 weeks since I hurt my ankle and I have yet to walk on it, and continue to use crutches. I have began doing palates strengthening for my ankle while laying down and it feels great. I feel like my ankle is functional and able to plantarflex, dorsiflex, invert, and evert with pressure applied against it. So I figure I should be able to stand. OUCH! I try to walk and I can't...flat footed it doesn't hurt, and it also doesn't hurt too much standing on tippy toes, but if I try to dorsiflex I get a sharp pain near my heal where my Tibialis Posterior tendon area is and it pinches bad if I try to walk! The pinch then shoots up my foot through the plantar fascias and almost to my toes. I also have little to no strength in my large toe being flexed down without it shaking, although it does not hurt. I have nearly no swelling left in my ankle, but just a small bruise left on my heal bone, and a bruise up on my inner calf area, and a slight bruise and pain on my shin muscle. Also if I try to stand up my foot gets hot and red. If you can shed any light on my symptoms I would greatly appreciate it. I have attached pictures of when I first injured myself, and how it looks now.
Thank you!!

RESPONSE

Hi Nick,
Here is your problem in a nutshell; you do not know if the ankle is fractured or not because you never had an x-ray. Your working assumption has been that you just badly sprained it, because you sprained it once before and the accident seems similar.
Nothing could be further from the truth. Even with an ankle fracture, the swelling and eccymosis (black and blue) will eventually start to subside but your inability to put weight on the foot is a tell tale sign that there may be more going on here than just a bad ankle sprain, particularly since it has been four weeks and I am assuming you are fairly young and in good health.
If there is a break in one of the bones, the severity of the break needs to be determined. If it is a simple "crack" in the bone and the two ends line up properly there is a chance it would heal uneventfully, but you would have noticed some improvement in your ability to bear weight at this point and apparently you have not.
The bigger problem is if the break is more severe and either the bones are displaced meaning they are too far apart to heal on their own, or if the fracture is a fragmented type of fracture where there are small pieces broken off, in either case the bones will not heal properly, if at all, and you will be left with a permanent disability.
You MUST go have an x-ray to determine the extent of damage to the ankle. I am concerned that after four weeks, even though the ankle looks better it does not feel better. I would not be surprised at all to find out you have a fracture.
Unfortunately, this is not a medical condition you can treat on your own. As an added note, stay off-weightbearing with crutches until you are seen by a doctor as you will do less further damage to the ankle.

Marc Mitnick DPM
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