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Tuesday, October 12, 2010

Ankle Sprain: Advice from Afar

Dr. Blake,
You were recommended to me by Dr, Pribut, In Washington DC. I live in Santa Barbara.

I recently injured my ankle. It is very serious, Lots of pain, swelling, etc. I did a classic roll of the ankle coming down from about 4 feet in height off of a rock climbing move. I heard a loud pop at the time of the trauma. The Orthopedic I saw at my local clinic diagnosed it as an anterior inferior tibio-fibular ligament tear. He also said, “probably other ligaments have torn too”. I am 50 and have had many ankle sprains in my life, the Orthopedic took x-rays and said my history of multiple injuries probably prevented it from breaking. He did not see any fractures.

He went quickly to a diagnosis and put on a removable cast, ordered physical therapy and told me he didn’t need to see me again, but to follow the instructions of the physical Therapist. He also said this injury could take 2-3 months to heal.
I have been experiencing ankle pain for some years and in the x-rays, there is a lot of indication of arthritis tissue. Having a proper healing is extremely important to me and I would gladly get myself in to see you if you were available for an appointment. Dr. Pribut recommended a second opinion and I’m worried the local clinician may have rushed through it. I can have the x-rays sent to your office if necessary. Can you offer some input?


Dear Marty,

     I am honored that Dr Stephen Pribut recommended me. For all of my readers, you should definitely check out Dr Pribut's informative website.
Athletes come into the office all the time with their "worst" ankle sprain. When they tell me that they have had multiple sprains, I always ask where the most current one fits into the range of severity with the other ones. Is this your worse one on this side of your body? If they answer yes, red lights should be flashing. This may be more than an ankle sprain. After the first sprain, with the ligaments torn or stretched, the ankle joint has the ability now to go further, rattling the bones around under the skin, and possibly causing more damage. With any ankle sprain, there is the risk of chip fractures, cartilage injury, and tendon injury. This is along with the definition of a sprain: an overstretching (grade 1 sprain), a partial tearing (grade 2 sprain), or a complete tear of the ligament(s) (grade 3 sprain).

     By the sound of your description, you have more severe damage until proven otherwise. You need an MRI to identify what has been injured exactly, so that the exact treatment can be outlined if possible. You have a better chance of healing properly if we know what is wrong. It is so common to bruise the cartilage in your ankle with a sprain like this, and that can take 2 or 3 years to mend if at all. Of course, this is the worst case, but if this is you, please show this to your family doc and get an MRI of the ankle ordered. With a bad ankle sprain, just going to physical therapy, if you have cartilage damage could make you  worse. The physical therapist will treat the diagnosis of an ankle sprain, not a fracture or cartilage problem. The therapist can only go off of the perscription.

     Once we know what is wrong, appropriate treatment can be obtained. Self pay for ankle MRI at our hospital is $650 so this is an option. Please comment privately through my email, or by posting a comment on this post. I hope all this makes sense.  Rich Blake
PS If you start PT, avoid sharp pain. Read the post on Good Pain vs Bad Pain and follow it closely.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.