Question
Hello.

Since August of 2009 I have had pain, swelling and bruising on the outside of my left ankle.  This started after re-roofing a house that took 8 days to do, over a 11 day period.  I know pain is common for working on slanted surfaces, especially slick surfaces.  After a few weeks of not getting any better with rest, ice, elevation, and compression I went to see a general practitioner because I had a superficial blood clot in my leg earlier in 2009.  It was proven not to be a blood clot.  Later after a blood test and medicine not helping, gout was ruled out.

In January of 2010 I went to see a foot specialist that was recommended.  After x-rays were taken, he didn't see much that could cause pain in this area except for an os trigonum bone that was 搇arger then ones he normally sees?but with no pain when bending the big toe it was thought that it wasn't a problem.  Then after a brace, walking boot, and time off of construction work did not help, I had an MRI that showed some damage to the tendon and inflammation around this extra bone and the doctor cut it out.  During the first surgery, in October of 2010, the os trigonum bone was found to be broken but was unclear if it was broken before or during the surgery.  After a time period of 6 months of no overall improvement was seen I was referred to another specialist that does feet and ankles.

On the first visit to this doctor, she saw that my left foot was turned out, the tendon was popping out of the grove, and the only was to fix it was surgery to address the root causes.  During second surgery, in April of 2011, the grove in the fibula deepened, the calcareous cut and straightened, and repairs to the tendon that "looked like string cheese." Now, after a year of therapy, many different medicines that help with nerve pain, there doesn't seem to be any real improvement from before the second surgery except less bruising.  The doctor is convinced that all the problems come from nerves in the area that were damaged or caught in scar tissue causing pain.  Since the Lyrica has shown no signs of helping the next step she wants to take is to go back in to remove the scar tissue and if needed cut some nerves.

It feels to me that the doctor has become fixated on this idea and doesn't want to explore other possibilities right now.  She has attributed the swelling of my foot, instability, and sudden sharp, short, and often debilitating, pain to this one factor.  She has also overlooked the popping of my ankle four or five times a day, the fact that my foot is still turned out when I walk or stand, the worsening bruises on the inside of the left ankle, and what feels like the tendon moving around.  The popping in the ankle feels like it is in the ankle joint, it hurts some times and sometimes makes my ankle feel better, and only started doing this in the last four months when improvement stopped and seemed to actually get worse.

Recently, events have shown me that sitting on my knees and feet make my ankle feel more painful and swell more than just walking and standing do.  Also during some exercises there is a continuous popping feeling.  I just don抰 know what to do now; I just don抰 believe that the surgery to remove the scar tissue will help.  The constant pain I feel is in my leg just above the ankle and below the ankle away from the surgery site.  The sudden pains are always just around the back of the ankle, almost where I believe the tendon is.

I just really don抰 want to have another surgery that doesn抰 seem to help.  Seeing that I work in a physically demanding field, I don抰 want to be in pain that takes a day of rest to recover to the point of the normal pain.

Thank you for your time.

Answer
This Chicago, South Loop & Elmhurst Podiatrist of AnklenfootCenters.com says.......

Dear Mark,
Unfortunately in physically demanding jobs-especially if you are overweight-it makes it tough for a full recovery. Seek another opinion-perhaps from a board certified podiatrist in ankle surgery. Nerve damage does not explain your symptoms of stability & type of pain. Avoid a surgery that does not address your concerns. Lyrica will usually decrease nerve pain & at least alter the perception of that pain. A nerve conduction test would help prove/disprove the nerve theory. Trapped nerves may  produce increased pain or shooting sensations with  tapping of the painful area. Seek another opinion.
Hope This Helps!
 and
Good Luck!
The podiatrists of AnkleNFootCenters.com are specialists in foot & ankle pain.
We are located in Chicago & Elmhurst

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

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