Dr. Timothy K. Durnin - 10/11/2007

Question
Hello I have a question for you I'm also a "all experts Expert as well" Long story short feel down some stairs in mid June and twisted my foot up onto my leg. "ouch" walked on it for 2 weeks before I sought out help had x-rays they cam back negative. 2 weeks later still had pain went back MRI revealed bruising to 2 bones The cuboid and the Talus. Was bad enough that it was treated as fractures. Dr said MRI report just showed changes to the bone only. was placed in 2 non weight bearing casts for a total of 8 weeks. I'm 4 weeks out of the cast and when for PT for 2 1/2 weeks it felt okay returned to work last week and now I'm having a great deal of pain in the ankle area. It comes and goes but twisting and torquing of the foot seems irritate it the most also if the foot it jammed it hurts as well. It just below and in front of the knob part of the lower leg bone. The area is tender to the touch as well. Not much swelling is present and really hasn't been all along. what is the possibility that something was overlooked on that MRI? and could it be a cartilage issue? If there was a ligament issue that wasn't completely torn would it have healed while it was immobile? I hate to think that the time I spent laid up was all for naught! I know with out seeing it iT's hard to say what it is.


Answer
Hi Todd,

Actually it is quite easy to diagnose your present condition from the excellent history you relay.

First, you suffered a severe inversion sprain, this means you tore, to some degree, the medial talo-fibular ligament. This is the tender spot right underneath the "ball" on the inside of your ankle. This is called the mallealous. Unfortunately, these never heal 100%, they stay stretched and never tighten back up leaving the patient with looseness and chronic instability.

It's not all bad news however, there are effective treatments that strengthen and stabilize the ankle mortise. This is with a wobble board, I suggest going online and buying one shaped like a circle with a ball under it. Get professional coaching on its use and work it at home to save money. You will always need to periodically do this due to the nature of the injury.

The other described traumas are nothing clinically significant, you have periostitis or a bruised bone, again;, ice and rest for a month or two should produce significant results. Expect flare-ups 10-12 months down the road, this is common with these injuries and are nothing serious, they don't usually last long and happen when certain stressing movements re-initiate inflammation. Just re-ice the area again and rest it until it feels better.

Otherwise, the MRI ruled out anything serious but does point out a clear need for competent follow-up to prevent future degenerative changes in the ankle ligament; this will spur if not treated properly with therapeutic ultrasound.
I would see a Chiropractor that comes highly recommended and not one with the biggest yellow page ad. Ask around and find one that has a decent sized office with lots of equipment. A National graduate would be best but they are hard to find, avoid Sherman and Life graduates, they lost accreditation and are basically diploma mills. The other schools are decent and should solve the problem.

Good Luck!

Dr. Timothy Durnin