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where to go from here? (ankle mri)

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  • where to go from here? (ankle mri)

    hi everyone, glad i have found this forum.

    i just recently received my mri report that states:

    Thank you for referring this 21 year old patient with a clinical history of recurrent injury for right ankle review.

    Bone and Joint: No osteochondral defect of the talar dome. Altered marrow signal intensity with osteophytic spurring medial talus and some subtle altered bony contour. signal intensity anteromedial tibia. Trace of ankle joint fluid and synovitis. Bony ap"osition medial malleolus level and some altered marrow signal intensity wiinin. No overt fragmentation of bone. The enthesophyte is prominent medialand aspecf of the bony anatomy imageo. No focal abnormality.

    Soft Tissue:
    Ankle Ligament: Lateral ligamentous complex anterior and posterior talofibular ligament intact' Partial tear with increase in size and altered signal-intensity associated with synovitis.
    Anterior Talof ibular Ligament: posterior talofibular ligament intact

    calcaneofibular Ligament: Not clearly visualised as separate structure with some increased signal intensity suggests partial tear. Medial ligamentous comprex partial tear with increasing signal intensity and disrupted morphorogy anteriorry smarr region.


    Achilles Tendon: lntact.
    Plantar Fascia: lntact.
    Extensor Tendons: lntact.
    Flexor Tendons: Trace of tenosynovitis tibialis posterior.
    Peroneal Tendons: lntact.

    Evidence of previous repetitive trauma with bony aposition anteromedial anterior tibia and aspect medial and medial aspect malleojus.
    Partial tears as described lateral and medial ligamentous complex.
    Synovitis anterolateral aspect of joint with smitl fibrous like region anterolateral gutter
    Review for impingement recommended.

    i've basically had chronic ankle sprains for about 5 years now. usually i can deal with most, the last two have been hell. the first of the two occured exactly a year ago, lots of swelling, bruising, etc. felt almost back to normal by september but then hurt it again, skateboarding, like every other time.

    the september one was different, my foot felt like it went forwards. it immediately swelled up, not as much as the last one, no bruising, and it was mainly around the front, lateral and medial parts. rom was decreased for a little bit. i gave it a few weeks to heal, then tried to skate again, the swelling and pain came back. went to a physio i had previously seen, said my ligaments were too loose.

    started prolotherapy in november. started to see some improvement, but anytime i went skating again the same thing would happen; swelling and some pain. this has been going on for about 4 months. i've been receiving prolotherapy each month for the four months, too.

    until, i got the mri report the other day. i've immediately stopped skating, i'm going to try rest it for at least a month-6 weeks. i'm sure the synovitis is the swelling that is re-occurring. hopefully i haven't aggraveted it that much that it won't go away. i've been resting and elevating my ankle. i don't believe ice or heat is neccesary because i haven't skated for about 2 weeks. it starts to feel better with rest, but i only give it a couple of weeks then go skate and the swelling and pain comes back, even if i take it easy. my ankle still doesn't bend like the other one, there's still some cracking on lateral side (before it used to be all over the place, lateral and near the achilles), and my medial mallelous is much larger than it should be (i think its been like this for a while now, but i can't recall it ever being this big). i can walk fine, run even, walk up and down stairs without a problem. however, squat or putting a fair amount of pressure does hurt on the front, where it looks like impingement would occur.

    i've also been wearing orthotics for about 7 months.

    i've got another appointment for prolo in a week, the prolotherapist is also a podiatrist so i hope he has more advice to give me. believe me, i have asked him several things. i even asked him if it could of been impingement a couple of months (prior to the mri) and he really didn't have an answer. sure the prolo will help those partial tears, but what about everything else? will i need surgery? or just more rest? honestly my ankle looks deformed, much larger on both sides, but it feels like bone especially on the medial side. (also had an x-ray confirming that). will i need that shaved off? i have tried to book an apppointment with surgeons but i bail at the last minute. surgery is the last thing i want.

    i'm really tired of this, it's so depressing. if i can't skate, well, then there's no point of doing anything really.

    i'd greatly appreciate some help or advice

    Last edited by tiltmode; 10-02-2012, 11:02 PM.

  • #2
    ********EDIT: when copying and pasting the mri some typos have occurred. let me know if you have trouble understanding any and i will fix them up when i have time.


    • #3
      Hi tiltmode

      Sorry its taken a while for anyone to reply. The forum has been quiet for ages and I gave up checking!

      I also suffered from ankle impingement, although I did not have current ligament damage I did have ostechondral defects in the cartilage. Like you I had sprained my ankle a number of times over 5-10 years, each time the ankle recovered and I thought nothing of it, until the last time when it didn't heal on its own and got progressively worse despite regular physio.

      Have you talked through the diagnosis with an orthopaedic surgeon? If you feel you have exhausted the possibilities of Physio and Prolo (not sure what that is?) then that is the next logical step. My experience was that most physio's don't like to recommend talking to surgeons and try and fix things without surgery (very sensible in general maybe). However, in my case the impingement was so severe that having it removed turned out to be a very good solution and I really don't think it would have got better with Physio alone.

      I had keyhole surgery to remove the osteophytes (this is what they called the growth that impinged the movement of my ankle) and they also did some repair work on my cartilage. It was a short surgery, but because of the cartilage damage the recovery time was increased from 6 months to a year.

      If you want to know about my surgery and recovery etc let me know. I don't want to bombard you with information. But I really do think you need to speak to someone about surgery given all the things you have already tried.

      And I well remember the desperation I felt at losing my mobility and sporting activities that you describe. Its really really tough.


      • #4
        hey Tasmin,

        thanks for the reply, better late than never haha.

        I ended up going under the knife. One week exactly. I finally got all the info I needed on impingement; basically that surgery is the only way to go, to remove those bone spurs. And, that's exactly what I did. Plus some other work, lateral re-construction and an osteotomy of the medial malleolar.

        How was your recovery? Your impingement problem sounds much worse than mine. The surgeon said all my cartilage was intact which was a relief. It's felt like I've done so much damage to my ankle over the years I was preparing for the worst. I only had two small spurs that were shaved off, I'm not sure how much tissue was being pinched/removed but I'll ask about that next follow up with the surgeon.

        My ankle however was really loose and unstable hence the lateral reconstruction. I knew it was loose but the way my surgeon moved my ankle made it feel like it was so much more unstable. Also happy on rhe shaving of the medial malleolar because i had so much constant pain on the inside of my ankle for at least year. The bump was noticeable and the x-ray showed really how much extra bone there was. Every other opinion I had got was that it was my posterior tib. I don't think it's that, the pain was much more of a bony pain, when i bent my ankle inwards then where the extra bone was getting in the way of things.

        Really glad I got the surgery done. Should of got it done as soon as I got the mri back. I was a fool for thinking physio would fix impingement, it did help with some ROM but not enough. I was considering not getting the reconstruction for a shorter recovery like you mentioned, with just an athroscope operation i would of been back skateboarding in half the time. The reconstruction is going to set things back but it's worth it. In the long run i'm not going to roll it as often. All in all i'm happy with how things are going. Gonna work hard on the physical therapy. I hope your recovery was a good one.

        Time to recover!


        • #5
          prolotherapy is a method where they inject a solution into ligaments/tendons that fakes an injury for your body to then naturally heal itself. the theory is your body creates more collagen and thus your ligaments become thicker/tighter/stronger. a lot of people try it before opting for surgery. it was useless for my injuries. the thing is no one picked up on the osteophytes on the x-ray until later when i got the mri. so i thought it was just a ligament problem and the other extra bone growth. but, the way my ankle moved when i visited the orthpaedic surgeon shows that it really didn't nothing.

          my operation was pretty quick, too. only 45mins-1hr. i fell asleep even before they got to me, then i woke up after it was all said and done. wouldn't of had it any other way. also, ended up staying the night at the hospital. getting around is still a little hard right now, i'm non-weight bearing for another week. i get the plaster off in about four days then im into a boot. do you know if cycling is any good for recovering? i know everyone recommends it for knees. maybe ill just stick to swimming.


          • #6
            hiya tiltmode

            glad to hear you got some information from somewhere, and had the operation. Great news that your cartilage was intact. Woop! How's it going now?

            You asked about my recovery - it was hard work and quite dark at times as I did feel it had got worse in some ways, despite being a better shape, and knowing that all the bad stuff had been taken out. I suspect yours might be easier (?) because your cartilage is intact, but then I'm not sure about the ligament stuff you talk about, so maybe not.

            I did physio twice a week, plus exercises every day/couple of times a day for several months. My time on crutches was about 6-7 weeks including 3 weeks roughly non weight bearing. Do be careful whilst you are on crutches - I damaged the knee on the other side by trying to do too much on one leg! Nobody told me this stuff...

            Cycling (on an exercise bike) was actually good therapy for me. It got the joints moving again, and helped stretch out some of the ligaments that had tightened up whilst the ankle was impinged. Obviously swimming is good too, although I don't think it was comfortable immediately, due to the pain when the ankle was stretched out flat and I didn't feel too steady on my feet for a while either.

            The year I spent in recovery was very frustrating, but I see now that it was very important and perhaps laid the foundations of a pain free life, so I would really recommend that you take your time over it and try and heal for the long term.


            • #7
              hey Tamsin, all is well, thanks.

              I went and saw my surgeon for a post op appoitment and he said it couldn't of looked any better for the 3 week mark. I'm in a aircast now, off crutches and i'm about to start physio in a week. I can fully walk on it with the cast and I get rid of it in a week, things are moving quick. I've been given one exercise that i've had to do since I got out of the back slab. Just the dorsi and plantar flexion exercise, i do that everyday as much as i can. the only pain i have is with some dorsi flexion, still feels a little stiff but nothing to be worried about at this point. honestly, the pain isn't at all what i expected. i've had sprains that have felt worse than this. when i take the aircast off and especially at night it feels pretty good. i can feel little improvements day by day. the swelling is slowly going down, too. the bruising has gone. it's looking pretty good right now.

              you're right about the crutches! they're a pain. my left knee started to feel the effects from hoping around too much on my good foot whenever i wasn't using the crutches. someone told me to ask my physio for some light knee exercises since there is a chance you can damage your knees during the recovery.

              i'm really focused on my recovery. i've made my diet as healthy as possible, and have quit alcohol (been about a year since my last drink). i'm going to get my bike back up and running so i can ride everywhere. that'll be a good way to keep fit. i will be doing physio sessions twice a week aswell, then later move onto once a week. i will make sure i do everything they tell me, but not to over-do it. there's no chance of slacking off, either.

              thanks a lot for your reply! everything is looking good, just wish i got it done earlier... there will be some dark times ahead for me, too, as i won't be able to do the thing i love for another 4 months, its a long time but 2 months has already gone by, i'm almost half way there!

              thanks again.