Ankle Pain

[Cammiecat]

In 2004 I fell and suffered a right trimalleolar fracture for which I underwent surgery at Mayo.  At the same time, the ligaments of the left ankle tore although I wouldn't know that until two years later.  The left ankle was reconstructed in 2006 with a lateral repair of the ligature.  Since 2004 I have had constant pain in my ankles.  Some days better, some days worse.  I have been trying to stick to an exercise program that includes swimming and other low impact activities.  I also occasionally take 1/2 a Lortab 5/500 along with 500mg APAP.  Yesterday I felt like I was at the end of my rope.  The pain was so bad it was incapacitating.  Is there anything that might benefit me that I'm not already doing???

[J T Junig, MD PhD]

Thanks JayBay-- I feel like I can just go on vacation any time!  I liked all of your suggestions, particularly the idea of strengthening the muscles that control the movement of the foot at the ankle.  The problem is that the ankle is just a very vulnerable structure-- carrying all of the weight of the body on a thin pile of bones, with a few ligaments along the sides...   As you said at the start, once a severe ankle injury has occurred, one must take care to avoid further injury-- not find ways to block the pain and allow more injury to occur.  The emphasis should be on stabilization, external bracing if necessary-- and giving up the activities that caused the original injuries.

[Cammiecat]

I had physical therapy for quite some time.  PT was done both on land and in the therapy pool.  I was on Ibuprophin for a long time and was taken off of it when my creatinine level started to rise.  I do take one or two now and again but never on a regular basis.  I like my kidneys to work more than I hate my ankle pain.  I like the ideas about the heat before and ice after exercise.  I will be trying that.  I'm going to be looking for a pain management program, but without insurance, it is a bit difficult.

[Jaybay]

I'm not the doctor, but I've had plenty of experience with sports and orthopedic injuries.  One thing I can say with certainty is that nothing is ever quite "normal" again - even after surgery.  There are some things that simply have to be lived with.  That's not to say there aren't things that might help improve your life.

Swimming is a great idea, but I wonder if you've had intensive physical therapy to help build up the specific muscles in your lower legs, ankles and feet?  Sometimes you just need to find the right person to focus on a problem before you see improvement.  

When you exercise, try applying heat for 15 minutes before you begin.  When you're done, ice the ankle for 15 minutes to help control inflammation.  I'd about bet money that you have some pretty bad arthritis in that joint by now, so you need a regular anti-inflammatory like advil or aleve rather than tylenol - that's the APAP contained in your lortab.  Tylenol is useless as an anti-inflammatory.

One simple exercise that can help build up your ankle muscles is to rise up slowly on your toes like ballet dancers.  You can use a doorway to help.  With feet shoulder-width apart or slightly less, place the balls of your feet on the threshhold of the door, which puts your heels lower than your toes.  Very slowly lift your heels off the floor until your weight is completely on the balls of your feet.  Do that 5 times daily to start, and increase one repetition a day.  Eventually, try it one foot at a time.  Make sure you use the doorway or another object or person to help keep you balanced.  Watch that you don't put your weight into the backs of your knees, as that is a weak position and doesn't fully work the targeted muscles.  The stronger the supporting muscles are around your ankles, the less pressure is placed on those joints as you move around during the day.

If you haven't been to a pain management specialist, now would be a good time to ask for a referral.