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Chronic Sprained Ankle
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Chronic Sprained Ankle

I sprained my right ankle two years ago and it is still very painful and swollen.  Now I am getting the pain up my right leg to my knee.  Is it possible that there still could be something in the ankle and on the leg?
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Avatar_n_tn
Hi Cmass,
How are you feeling now?
What is your name and are you a sportsperson?
Ankle sprains cause sequential disruption of: Anterolateral joint capsule, Anterior Tibio-Fibular Ligament and Calcaneo Fibular Ligament.
The injury results from inversion of the foot with the ankle in varying degrees of plantar flexion when weight is placed on the ankle.
Did you consult an orthopaedician before and if so, what he has to say about it?
Was there any imaging being done to rule out any factures?
Differential diagnosis includes Fibular fracture, peroneal tendon subluxation, Talar fracture or Calcaneal fracture.
I think you should be seeing an orthopaedician and get imaging done to decide regarding further course of action.
Hope this helps.
Keep me informed about your decision and regarding your consultation.
Bye.
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Avatar_f_tn
My name is Cassie.  I sprained right my ankle by practicing soccer in my backyard and kicked the ball over the fence.  I climbed the fence which is over five feet tall (taller than I am) and I twisted my body around to avoid a garden on that side and landed in a hole and heard a "pop".  I laid on the ground and could not move at all.  I went to the doctors and they diagnosed me as a sprained ankle.  I got an MRI done recently and my ligaments are still swollen from the ligaments I injured two years ago.  I keep going to differrent doctors and they are referring me to Orthopaedics, but a month from now.  It has been two years since I injured it and now the pain is just getting worse.  The pain is on my whole ankle and foot and up my leg and knee.  Now I am noticing a bump on the top of my right foot.
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Avatar_f_tn
My name is Cassie.  I sprained right my ankle by practicing soccer in my backyard and kicked the ball over the fence.  I climbed the fence which is over five feet tall (taller than I am) and I twisted my body around to avoid a garden on that side and landed in a hole and heard a "pop".  I laid on the ground and could not move at all.  I went to the doctors and they diagnosed me as a sprained ankle.  I got an MRI done recently and my ligaments are still swollen from the ligaments I injured two years ago.  I keep going to differrent doctors and they are referring me to Orthopaedics, but a month from now.  It has been two years since I injured it and now the pain is just getting worse.  The pain is on my whole ankle and foot and up my leg and knee.  Now I am noticing a bump on the top of my right foot.
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Avatar_f_tn
I sprained my right ankle two years ago and it never healed properly.  I was practicing soccer and kicked the ball over the fence.  I climbed the 5 foot fence and jumped over and twisting my body around to avoid the garden on that side and landed in a hole.  I heard a "pop" at the time of injury.  I got an MRI done recently and it showed swollen ligaments.  Now the pain is much worse and it goes from my ankle, up my leg, to my knee.  I also notice when I press down on the left side of my right ankle I have alot of pain.  Also, when I press down on the bones on my leg, I am also in alot of pain.  Should I get more tests done? Could there maybe sonething wrong in the leg also?

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Avatar_f_tn
Thank You for your reply.  I am in excruciating pain from my anklr up my leg to my knee.  I want to go to the hospital.  Do you think I should go?  I have an Orthopaedic appointment, but that is a month from now.  I cannot wait.  I need help now.

Cassie
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Avatar_n_tn
Hi Cassie,
There was some up gradation work going on website, hence could not reply to you early.
What are the medications you are on? What has the treating doctor prescribed you apart from reference to an orthopaedician? Are you walking without crutches?
Let me explain you the line of management.
In initial few days of your injury, you should be following RICE protocol which is as follows,
Rest: no weight-bearing activities for the first 24 hours after the injury.
Ice: apply ice packs to the area that is painful or the focal point of the injury. Apply ice intermittently for the first 24 hours, utilizing a pattern of 20 minutes of ice followed by 60 minutes without ice.
Compression: apply an ACE bandage or other elastic wrap to the ankle to help prevent swelling.
Elevation: elevate the ankle to reduce swelling. By having the foot positioned higher than the hip (or heart), the force of gravity is used to drain swelling out of the ankle.
Did you follow RICE protocol? Did any body recommend you about it?
After the initial management, you should be taking some general steps like,
There should be partial weight bearing with crutches in the acute phase (first 3 to 7 days), which is advanced as tolerated to full weight bearing.
You should be putting up ankle brace to facilitate early ambulation.
NSAIDs may help with pain.
Gentle active Range Of Motion as tolerated is advised.
For severe sprains, consider a formal strengthening and proprioception retraining program with physical therapy.
Activity modification (rest, sports restriction) until strength returns.
You should be seeing emergency room doctors soon and get imaging done or your chronically sprained ankle joint.
Keep me informed regarding your thoughts and any other related queries.
Bye.
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Avatar_n_tn
Hi Cassie,
I want to know what pain meds you are on? How are they spaced out over 24 hours a day?
What dosages you are taking?
Bye.
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Avatar_f_tn
I am currently on pain medications for the ankle pain but they are not working. I got referred to Orthopaedics but it is not till a month from now.  I am in so much pain it is hard to sleep and hard to elevate also.  I am worried because it has been so long (2 years) since I have injured it and now the pain is getting worse and it goes up my leg to my knee.  I use cruthes but I get bruises on my sides so it is hard to use them all the time.  When I am not using them, I have to limp around.  I also have a bump on the top of my foot that is also painful.  I do wrap it with an ace bandage.  I did follow the RICE method but after a few days the swelling got worse and the bruising was all over my foot.  I know I should have took action right away and go to the ER.  I still cannot believe it has been 2 years and I am still in alot of pain.  The pain medication that I am on is IC TRAMADOL HCL.  I have to take 1 tablet every 6 hours.  That is not even helping.  
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Avatar_n_tn
Hi,
I have some suggestions, if you feel they are worth trying before you meet your orthopaedician, then go ahead and try it.
Firstly, I think the nerve in ankle is getting injured or diseased, as now you are feeling that your knee is also feeling the pain. Slowly the pain will move upwards and you would feel pain in hips too.
Secondly, you should visit Emergency room and get an imaging done to rule out any other pathology and also if newer pathology has developed.
Thirdly, your pain meds needs to be reviewed. Your pain meds should contain 2-3 different class of drugs. All 3 medicines need to be started at same time. They should be planned over a period of 24 hours. No 2 medicines should go at same time of day. There should be effective coverage over 24 hour’s period.
Fourthly, mild physiotherapy with steam fomentation will help a lot.
You should undergo propioceptive training.
Propioceptive training has been shown to decrease recurrent sprains.
Keep me informed.
Bye.
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Avatar_f_tn
I know I should go to the Emergency Room but my insurance doesn't cover it that much.  I have a private insurance and I am still going to have to pay about $3,000.  Is there any way I can talk to the hospital and try to work it out with them?  I know I need to see someone immediately with all the pain that I have.  The pain medications are not working at all.  I know that I am in alot of pain in my ankle, up my leg, to my knee, and it has been 2 years since I injured my ankle and the pain is awful, but you said that the pain will eventually go to my hip?  Are you serious?  How can the hip be affected?
Cassie
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Avatar_n_tn
Hi Cassie,
I would like you to know that the nerve supply from hips downwards to foot originates from lower back. You said that your pain had started in ankle and then it progressed further up to your knee.
Firstly, the nerve is same, hence due to irritation of nerve the nerve to your hips would also get irritated and hence pain.
Secondly, while walking you might not be able maintain normal posture and also your gait might be disturbed which can cause more strain to your hip joint thus leading to more pain.
Do you feel your gait is affected?
I think you can try calling up hospital and see what they have to say about this, whether they can take you up or do you need
Keep me informed.
Bye.
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Avatar_f_tn
I do limp when I am not using my crutches.  When I walk normal, the pain is awful so I try to do everything I can to keep the weight off my ankle.  I don't use my crutches all the time because I get bruises on my sides so I just limp around and use the crutches from time to time.  I do understand now how the hip would be affected.  I do have an Orthopaedic appointment a month from now but like I said the pain is so bad that I should go to the hosptial.  Do you think I will get the pain in the hip anytime now?
Cassie
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Avatar_n_tn
Hi Cassie,
I might not be in a position to say as how fast the pain will come to hip.
What medicines are you on?
You can use crutches as and when necessary, which will reduce the pressure exerted on hips.
Limping is bad and I think you should be evaluated as soon as possible. You can talk to orthopaedician about and take an appointment date a little bit early.
Keep me informed.
Bye.
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Avatar_f_tn
I am taking prescribed medication (Tramadol) for my ankle but they are not working.  I am also taking advil and tylenol but they are not working either.  I called Orthopaedics to see if they had any earlier appointments but they said that they have no other earlier appointments.  Is the pain in the hip due to limping or the chronic ankle sprain?  I will go back to the doctor and ask him if I could possibly get a referral to Podiatry? Maybe I can get into that earlier than my Orthopaedic appointment.
Cassie
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Avatar_n_tn
Hi Cassie,
I feel sorry that you are going through all this and the situation is helpless.
Well what we can do is try to get a podiatry reference as early as possible.
The pain in the hip is due to both limping and also due chronic ankle sprain. Your ankle sprain is making you limp and your limping is causing you to have pain in hips.
I strongly feel that you should continue Tylenol pain relief with Advil and also Tramadol.
Can you tell me at what time each of this drugs you are using?
I mean time schedule.
I wish you all the best and take care of yourself.
I think you would get a podiatry reference soon.
Bye.
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Avatar_f_tn
I am taking Tramadol twice a day, once every six hours.  I take Advil every 4-6 hours and same for the Tylenol.  I think that I can get into Podiatry sooner but, I will still keep my Orthopaedic appointment.  I get worried alot because the pain is so bad.  With the pain all on my ankle and my foot and also up my leg to my knee, I have been also noticing that when I put my hand around just above my right ankle, on the left side, and where the swollen part is on the right side of my right ankle, as I press down on the bones I have alot of pain and also when I press down on the bone on my leg I have alot of pain.  All of this and including the other pain is really worrying me.  Also, do you know what the bump on top of my foot, just below the ankle, could be?  When I press on that it also hurts.
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Avatar_n_tn
Hi Cassie,
I feel you can schedule your drugs in following manner.  You can take Tramadol thrice a day every 8 hours apart, Advil six times a day 4 hours apart and Tylenol six times a day 4 hours apart.
Typical schedule for 1 day would be as follows.
8am- Tramadol, 9am- Advil, 11am-Tylenol,
1pm-Advil, 3pm-Tylenol, 4pm-Tramadol, 5pm-Advil,
7pm-Tylenol, 9pm-Advil, 11pm-Tylenol, 12am-Tramadol,
1am-Advil, 3am-Tylenol, 5am-Advil, 7am-Tylenol.
I think this would help you a lot.
In my previous post I meant that you should take podiatry reference as early as possible and keep orthopedics reference as scheduled.
Is it a swelling? If yes, then is it hard or soft? Is there any discharge? Do you have fever?
I think it is swelling due to inflammation around the ankle joint.
Keep me informed.
Bye.
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Avatar_f_tn
What I don't understand is why am I feeling the pain up my leg and knee too?  My knee tends to lock up on me and I cannot move it sometimes and is very sore.  When I kneel down sometimes and I get up my knee locks up.  I think there maybe something in the leg too.
Cassie
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Avatar_n_tn
Hi Casisie,
Your symptom of knee lock while sitting down and getting up suggests there might be some meniscus pathology of knee joint.
Bye.
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Avatar_f_tn
Is the meniscus pathology of the knee joint due to the old chronic sprained ankle?  I could have done damage to the knee as well because at the the time of injury my whole body was in a twisting motion and I didn't stop twisting until I hit the hole in the ground.   Remember, I jumped from a 5 foot fence so twisting my body around and landing in a hole could of did more damage than I originally thought.  I know my ankle was bad enough and still is bad but it never occured to me at that time that my leg and knee could have been involved also.  Since the pain is getting worse (meaning all on my ankle, my leg, and knee, I do know there is still something wrong with my ankle but also something wrong with my leg and knee.  What I also don't understand is why does it hurt when i elevate it?
Cassie
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Avatar_n_tn
Hi Cassie,
When is your appointment with Podiatrist? Did you take one?
It is possible that you could have hurt your knee or components of knee joint during that fall.
Why did you jump from 5 foot fence?
Can you describe the pain after elevation? Where is the maximum point of tenderness? What you do that this particular symptom is resolved?
Your pain after elevation is from knee joint down or hip joint down?
Bye.
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Avatar_f_tn
I don't have an appointment with Podiatry yet.  I jumped from a 5 foot fence because I was practicing soccer and I kicked the ball over the fence so I climbed it and I jumped in the air and twisted my body around to avoid the neighbor's garden and landed in a hole.  I never stopped twisting around until I landed in that hole. So that is why I think I did something to my knee also.  My ankle and leg are also very painful and when I elevate it, I feel the pain everywhere, even on my knee.  The elevation is from my knee down to my ankle.  I cannot even stand up for very long because the pain is so bad.  I try to use my crutches at times but I did get bruises on my sides from the crutches so I tend to use them here and there.    
Cassie
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Avatar_f_tn
This injury is a chronic sprained ankle that happened 2 years ago.  I am worried because the pain is getting worse and is everywhere from my ankle, up my leg, to my knee.I probably need to go the hospital if I cannot get into Podiatry sooner than my Orthopaedic appointment.  
Cassie
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Avatar_n_tn
Hi Cassie,
I think you have hurt your ankle and your knee as well.
You want to say that you have not shown to any doctor for this injury.
You are saying you have never had any imaging done for your ankle or knee, though it was paining so much.
I wonder that you have not been to doctor so far.
You said you would manage to get podiatry reference soon hence I told you get one early.
I am worried about your pain and your ankle and knee joints too.
You said you bruise easily.
Is it only on using the crutches or otherwise also if you get hurt you don’t stop bleeding?
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Avatar_f_tn
When I badly injured my ankle 2 years ago, it was diagnosed as a bad sprained ankle.  As the years went on, the pain has got worse and I did get an MRI done a little while ago and it showed the ligaments were swollen.  I never got an MRI done on my knee yet.  I know I probably should get an MRI for my knee.  When I injured it years ago, I could have fractured a piece of bone either on the ankle, the leg or the knee.  I want to get more tests done.  I also heard from someone that she also sprained her ankle and after six months of pain she decided to get an x ray and an MRI done and they came out normal.  Then she went to get Ankle Arthroscopy done and she found out that she had a fractured Talus.  My question is: Why didn't the x ray and MRI pick up on the fracture?  If the x ray didn't pick it up, I would think the MRI would.  I am really worried because of all the bad pain I have and I could have the same thing as her.  I do use crutches but I do bruise easy.  I think you wondering if I bruise easy or if I get hurt and don't stop bleeding.  The answer is: I do bruise easy if hit my elbow or arm on something hard, but when I get cut, I do stop bleeding.
Cassie  
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Avatar_n_tn
Hi Cassie,
You question is relevant.
MR imaging is usually the best choice for examining the body's major joints, spine for disk disease and soft tissues of the extremities.
I always feel that it is not that X-ray and MRI has not picked up the fracture, but it is always the person who reads it would have confused it.
It can also be that in certain angulations, your fracture would not have been visible.
As you said that you stop bleeding easily after a cut says that there is no hematological concern.
When is your meeting with podiatrist and orthopaedician?
Keep me informed.
Bye.
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Avatar_f_tn
I see Podiatry in a week.  What do you mean when you said: "It can also be in certain angulations, your fracture would not have been visible"  I don't understand what you are saying there.  Can you clear that for me, please?
Cassie
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Avatar_n_tn
Hi Cassie,
I am sorry I was not around for a while; hence there is a delay in reply.
What I meant by saying “It can also be that in certain angulations, your fracture would not have been visible" is that on an X-ray, thin hairline fractures if not taken properly with correct angulations, correct exposure, it is likely that a hair line fracture could be missed.
Keep me informed.
Bye.
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Avatar_f_tn
I understand now.  Do you think a Bone Scan can pick up the hairline fracture better than an x ray?
Cassie
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Avatar_n_tn
Hi Cassie,
I would like to put in other way.
Plain radiographs in 2 planes are mandatory and should include the joint above and below the injury.
CT is better than radiography at identifying fractures of the spine and showing the joint involvement in intra-articular fractures.
MRI or bone scans may be used to detect non-displaced fractures.
Keep me informed if you have any queries.
Bye.
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Avatar_f_tn
Do you think I should get a CT scan done?
Cassie
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Avatar_n_tn
Hi Cassie,
How are you?
What happened to your appointments? Any consultation has been done so far?
Yes, you can get a CT scan done.
Keep me informed.
Bye.
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Avatar_f_tn
I am being sent to Orthopaedics late January.  I am worried because the pain is so bad, it does feel like a fracture.  Something keeps popping and cracking in my ankle and foot and when I knee on my knee, my knee hurts so bad.  It feels like something is poking at my knee joint or something.  I have no idea what it is.
Cassie
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Avatar_f_tn
Two weeks ago I got ankle surgery done to repair ligamnets and a fractured bone. My name is Cassie and I have been posting about my Chronic Sprained Ankle for a while to get some adivise. It really helped because I went to different doctors but they couldn't find anything, then I was referred to Orthopedics and I got a different x-ray view, a stand-up view instead of laying down on the x-ray table. It was then that there was a fracture on the right part of my right ankle. When he went over rmy MRi, he saw that some of ligaments had to be repaired and some of them has to be tighten. So then I had the surgery and had a cast on for 2 weeks and then he put me in a boot. It is still sore from the surgery, but that will go as time goes on. I wanted to keep you updated.
Cassie
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Avatar_f_tn
I feel and injured my knee and ankle, had to have surgery , was in the hospital for four months. I had a cast on my left knee and ankle.  when they removed my cast my leg and ankle was normal. but now my left leg and ankle is swollen so that i can not  walk on it without  being in tremendous pain. I am putting ice packs on them and elevating it but the swelling has not gone down. this has been for a month now. please help me with the inflammtion of my left leg and ankle.
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