Ankle injury after hit with a softball, vascular?

[Jon_E]

A little over 7 weeks ago I was hit by a ground ball along the distal, anterior medial tibia.  Minimal swelling, but iced for pain for about a week.  Didn't pay much attention to it since then other than a hematoma, but last Friday palpated about 2 inches distal to the hematoma and noted a tubular shaped hard mass running along the superior and anterior edges of the medial malleolus.  It is medial to the anterior tibialis tendon and seems to be in the exact location and orientation of a vein on my other foot; I think it's the saphaenous vein, but it not compressable.  It is hard for about 1 1/2 inches and when pressed on moves side to side.  I worked on the "hematoma" and it has shrunk, but not the hardness in the "vein".  I have no significant swelling, venous pooling, no range of motion loss, no strength loss, no skin color changes, pedial pulse appeared normal and no temp changes (great toe feels cold after working on the hematoma, however not to touch relative to the unaffected foot).  I don't think I was hit were the 'vein" has hardened; about 2-3 inches higher.  If it was a clot, shouldn't I have signs of venous insufficiency?

[Michael L Gross, MD]

A clot there would not necessarily cause venous insufficiency, since there is abundant collateral ciirculation.  However, superficial clots below the knee are not usually a cause for alarm.  Try using hot soaks to soften it up.