Chronic Sprained Ankle

[cmasse]

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?

[JainMD]

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.

[cmasse]

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.  

[JainMD]

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.

[cmasse]

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

[JainMD]

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.

[cmasse]

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