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Monday, November 12, 2012

Chronic Ankle Injury: Email Advice

Dear Dr. Blake,
I came across your blog while searching for an answer to my ankle problem; I am wondering if you can give me some idea?
I am a 22 year old female, BMI is in the normal category; I injured my right ankle when I was 12 (jumping down the stairs). From what I can remember, it was really painful but I didn't do anything (compress with ice etc) and I only went to the doctors some times after. I think the doctor said one of the ligaments is torn. I have been wearing ankle braces and minimize sports activity  (though still keep on running occasionally). There is not any problem, although sometimes in the morning when I get up, I feel the joint is a bit "tight" or sore but not up to a level that is painful and the symptom is gone soon after.
Dr Blake's comment: This is fairly common for joint injuries. The symptoms may plateau below perfect, but definitely manageable. There is probably some scar tissue in the wrong place, but the disability of removing it is far worse than the disability of leaving it alone. 
However, 2 months ago when I woke up (was woke up by the pain actually) the pain is unbearable, even if I did not touch the ankle. Standing was not possible and I had to use crutches. I went to the doctors and was diagonosed arithritis, happened for no reason (the blood test was normal). I took Naproxen sodium and Ranitidine tablet for 2-3 days before I can walk independently without crutches.
Dr Blake's comment: This may or may not be separate from the old injury. Sleeping in the wrong position for an extended period of time can cause the joint lining to be pinched. The joint lining is full of nerve endings and when  and when irritated are very unhappy. This pain normally goes down over 4-5 days, unless some extra scar tissue is stuck. The treatment for this acute type of pain is icing for 96 hours 3 to 4 times per day to reduce the inflammation. Arthritis always sounds bad and permanent and dark, but actually means joint inflammation. Yes, you had joint inflammation. The rest of the seriousness has to be followed and possibly explored with imaging. 
What I am not sure now is that my ankle is swollen, without pain. I do not notice if it is always like this (I know it is not completely right but never compare the size between left and right ankles). Since the incident 2 months ago, I stopped every sports and only walk and swim. I also have ankle braces on all the time no matter what. The swelling is positioned at the anterior part between Tibia and Talus bones and also a small part above the ankle. It appears to be twice bigger than my left ankle (normal one).
Dr Blake's comment: Pain in and around the ankle causing swelling. Long after the pain is gone, and the disability, the swelling can remain and remain. Up to 4-6 months longer than the pain. Ankle braces can hold in the swelling. Inactivity can also hold in the swelling. It is best to judge what you should and shouldn't do, and what you should and shouldn't wear based on pain. Remember the wise old adage of "Listen To Your Body". It was not look at the swelling of your body for good reasons. 
What do you think might be the cause to the swelling? And would you suggest to go for an operation or any alternatives? Is it possible to avoid surgery at all in this circumstances?
Dr Blake's comments: You irritated your ankle from sleeping funny, and this caused the initial pain. The pain was intense enough that your body tried to heal something by bringing in swelling. Now the swelling is trapped. Twice daily ice pack the ankle for 20 minutes, and once day do contrast bathes. See the blog for info on these techniques. Avoid tight fitting socks that leave a skin indentation. Your chance of surgery is less than 1% at this time, unless further info comes forward. You have surgery for unrelenting pain, never for swelling. Hope this helps. Rich
I am grateful for any comments that you have! Thank you for your time in advance.

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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.