Bone bruises(edemas) surrounding talus

[tal2009]

Dear Doctor,
Around 3 months ago, I twisted my left ankle playing soccer and slowly had trouble walking. It was very painful. I went to ER and was told that I have an ankle sprain. I have had this pain on-going with walking for a month and went to a doctor who told me that I should walk since I have a minor ligamentous injury. I have walked on it but the pain would go worse and worse. I have my doctor and the new one told me that I might have a crack on the talus. We made an MRI which showed bone marrow edemas on the neck, lateral processes and on the talus dome, the radiologists wrote that this is most compatible with bone bruises, microtrabecular injuries. I have not been in a cast, just a light splint, but it is very painful, now I don't walk, I am on crutches for already anothe month with no imporvement. I am bit confused what different doctors tell me, some say you need a cotizon shot, th others: a cast, the other doctos recoomended physical therapy since my whole foot began to swell. But I can not move my leg it hurts when I move it to the left especially. What should I do? and what is bone bruises is it a fracture? Should I be on a non-weightbering cast? How long should I wait until I can start walking? Should I use a bone stimulator?

Thanks

[Michael L Gross, MD]

Bone bruises can take up to 12 weeks to heal, so I would be patient.  When you rolled your ankle, one of the bones in your foot banged against another, causing a bruise. Essentially this is bleeding and swelling within the bone, and is usually self limitting, it gets better on its own.  Before we had MRI, we didn't see these on xray, and they went untreated.  Immobilzation in a removable brace usually is helpful in the acute phase, but at this point, I can't sayhow helpful it would be.  Physcial therapy may be useful to treat the surrounding soft tissue injuries and restore your strength.  I dont think a bone stimulator or crutches are necessary.