Ankle Sprain, healing times

[Una]

Hi, i'm looking for some advice relating to my ankle. I sprained it back in late April. Originally it was diagnosed as a Grade 1 sprain. I took the usual immediate actions and stopped playing, it was however complicated by a posterior impingement which has since resolved. But, there was concern that I had an avulsion fracture on my fibula around the attachment of the ATFL or there was some periosteal bruising present. We didn't X-Ray it after much discussion because of the fact that any small fracture would be healed 6 weeks later and it was stable. I am back playing football now with it strapped since June. But, there is still pain on forced planter flexion and inversion (and extreme eversion). If i didn't have it strapped it would hurt kicking the ball. It is also hurting when pressure is applied to general location of the ATFL (even though there was no isolated incident of reinjury since the initial event). I'm also experiencing cramping and delayed onset muscle pain around my calf, tibalis anterior and my peroneals which I am concerned maybe compensation.

My question is basically should there still be tenderness around the location 3 months later and is that cramping related to compensation? I will go to the physio to assess it but i don't want to throw away the cash (which i am slightly suck for) if it isn't warrented and i'm just being paranoid.
Many thanks for any help or advice you can give me.

[Unregistered]

Hi,

I am physio and was always taught that if the grade one is not better after 2-3 weeks...........you missed something.

I would start to look at a syndesmosis or even a talar dome bruise. I am thinking those cause of the pain with forced platarflexion and eversion.

For the talar dome bruise:
Lie down on your stomach, bend your knee and get a mate to smack you on your heel......see if there is pain.
Also, do inversion and eversion with the joint in plantarflexion and eversion......it will prop be painful in both.

For the syndesmosis......unfortunatley, the above will also be painful.
You can also sit on a chair and get your mate to squeeze below your knee, working the way to about half way down the calf. look at pain and compare the amount of separation between the tibia and fibula to the other leg. Also, get him to do forced dorsiflexion with eversion......you will prob. squeal like a girl, but this also indicates the talar dome.....

How did you injure it?
Could you walk after it?
HOw much swelling?
How much bruising?
Where was the swelling and bruising?

Often with the syndesmosis, people do not consider the antero-inferior tib-fib ligament. To check this, go to the lowest point of the tibia and fibula and feel just above the ankle joint..............

Worst case......osteochondral lesion (between the cartilage and the bone), this can easily take 3 months.....................

Sorry to be so vague, but let me know.

[Una]

Hi, thanks a million for your reply. I can't actually do those tests right now but i'll get back to you when i can. The physio definitely did check that though. The posterior impingment / talar dome bruising was discussed because i had pain / pinching sensation and a sometimes audible cracking noise in extreme planter flexion. Also the syndesmosis was looked at and mobilised but they didn't think that was the primary problem.
It will hurt if in forced dorsiflexion and eversion.
As for the anterior inferior tib fib ligament. It is sore down there right where extensor digitorum tendons and extensor hallicus come down above the Ankle Joint.

How did you injure it? I was playing gaelic football with my club. Had just taken a shot and was kind of mid air, my marker caught me off balance and i landed on the outside of my right foot heavily which went over immediately with an audible crack which a few people heard.

Could you walk after it? They had to pick me up. Initially i stayed on the pitch for five minutes but it became increasingly sore. I could walk on it with a limp. After two days I could walk but not run and definitely couldn't kick anymore.

HOw much swelling? How much bruising? Where was the swelling and bruising?
Not much, which was what confused myself and the physios. There was a kind of puffy patch anterior to the lateral malleolus kind of egg sized. It never went up like a balloon like ankles quite often do. The bruising itself was localised too. The swelling was spread down in the gutter between the ATFL and CFL (they did examine the CFL and said no injury there) and also superior to the the ATFL.
However, that swelling was still present 6 weeks later so the physio put a compression bandage on it. It helped slightly but if you compare left and right ankles now its still a bit swollen.

(This was the first ankle injury I ever had so there was no underlying history)

[injuryupdate]

Unlikely to be a bad syndesmosis or talar dome injury if you are back playing (even though you still have symptoms).

Most likely diagnosis - lateral gutter synovitis, treat with further ankle rehab (strengthening, mobilisation, strapping) and some anti-inflam gel or even a cortisone. If this lessens the pain, then nothing further needed. An MRI would help rule everything else out, but may be overkill if you can get through a match. The other question - if an MRI found a tiny talar dome osteochondral lesion, would you stop playing?

[Una]

Just in an update, my trainer sent me back to the physio. She seems to be of the opinion that it was bruising around the talus and the pain being deep to my extensor tendons is due to that. Also pain posteriorly on anterior drawer like something is caught. Basically she strapped it to the nines and will do so for my other games. She thought we could scan it but it was probably overkill. The ligament is coming on gradually. Basically it won't get better until I take time out from training, kicking footballs. I've three games left in club season and then i'm on hospital placement so i'll have no time to play college ball so that will be serious time out.
Thanks for all your advice and help

[Una]

Just one other quick question. With nature of injury I can understand some gym exercises might be a bit extreme on my ankle when i'm supposed to rest it ie weightbearing on a treadmill but how is cycling and swimming (and which stroke would be best to help it along? I found breast stroke too painful initially due to the eversion in the kick). Also are there any other things I can do to help it along in the gym?

[injuryupdate]

Swimming, cycling should be OK. Hopefully the injury will come good during the football off-season. If it doesn't might be worth a scan down the track. However, sounds like you can safely last 3 games.

[mick68]

Just one other quick question. With nature of injury I can understand some gym exercises might be a bit extreme on my ankle when i'm supposed to rest it ie weightbearing on a treadmill but how is cycling and swimming (and which stroke would be best to help it along? I found breast stroke too painful initially due to the eversion in the kick). Also are there any other things I can do to help it along in the gym?
Hi,
I've just recently done the exact same thing as you. Landing heavily on the side of my right foot in a tackle. Unfortunatly I had to be carried off and sustained an avulsion fracture to the medial malleolus and ruptered ligaments.
After two months I still can't run but I'm on the mend . What gets me though is this is not the first serious sprain I've had but every doctor I've gone to has only ever described the injuries as grade one ligament tears. Anyone could see that they're not grade 1's.
Cheers.Mick.

[Una]

Swimming, cycling should be OK. Hopefully the injury will come good during the football off-season. If it doesn't might be worth a scan down the track. However, sounds like you can safely last 3 games.


I lasted the three games but it did get inflammed in between them. So much so that while I was on my first hospital placement my intern and the radiology reg made me get an X-Ray and wanted me to get an MRI but then it resolved itself. (X-Ray showed no abnormalities so they agreed it was probably a chondral lesion). I'm to come back to them if it becomes inflammed again.
I'm just wondering could the intermittent pain be related to the fact I'm standing on my ankle for hours at a time at the weekend while I lifeguard and at my pool we tend to lifeguard barefoot?
Also, is Glucosamine worth a shot? My physio recommended it and I'm getting very mixed reports in online journals and from some pharmacists i know.
Thanks a million

[jessie1983]

I'm in need of some advice. I was at a friends house nearly 2 weeks ago and tripped, when i fell i landed on my right ankle and as soon as that happened the swelling was instant. I went to the er that night and as soon as the docotor walked in he stated "yes it's broken, but we'll get an xray to see how bad". Well to everyone's suprise it wasn't broken, they sent me home(making sure i knew the RICE treamtent). Well here it is just at 2 weeks later, my foot is very swollen. When i get up after a nights sleep it isn't swollen one bit, but within 3 hours of being up the pressure is so bad it seriously feels like my foot will explode. When it does swell my last two toes "drop" lower than the other toes. My ankle doesn't hurt, i am able to put pressure (standing) on my foot, but i'm unable to walk. I have done at home exercises to try and strengthen my ankle, BUT i'm unable to turn my foot to the left, nor can i turn it up. I really need some advice, i'm in a crunch with money so i'm unable to get back to the dr(have a 21 month old daughter, only my husband working, and no insurance)...if there's anything anyone else can suggest to me, please feel free too!

thanks for you time and for reading this~