Question
QUESTION: Hi Dr. Kats I'm not sure if this falls into you line of work or not. I'm 36 years old in good health a non smoker. 4 months ago I fell down chasing my son and twisted my ankle badly I went to an urgent care facility and it was x-rayed and they found nothing they aid it was a moderate sprain an maybe a bad bruise. I was given a air brace thing and was told if it didn't ease up to see an orthopedic Dr. It didn't so I did 2 weeks later I went to a OS and more x-rays and still noting conclusive I was sent for an MRI and it revealed a stress fracture to the Talus?? I was placed in a short leg cast for 4 weeks and then I returned for a follow up and it was still very sore and tender. I was placed in a second cast for 3 more weeks the whole time I was not permitted to walk on it. After the 3 weeks I went back and the cast was removed and the DR. pretty much expected me to walk right on out of his office That didn't happen. He did take a another set of X-rays I don't know why he didn't see anything in the first set but who am I to say.  after a week of limping around badly I called back and he prescribed PT which I did for 3 weeks the first 2 weeks helped a lot the last week not so much it was actually hurting it some. I haven't had any more Pt but have been doing the exercises the therapist gave me to do. okay that's the history now I'm still experiencing pain and discomfort in the ankle joint on the inside of my leg almost on the top of the foot right where the Talus would be?? It is a constant pressure feeling and from time to time a burning sensation. I can walk okay without a limp anymore and side to side movement it bearable but if it twist or am walking and change directions I really feel it. Is it possible that something could have been missed on an MRI some kind of tissue damage? Thank you so much for your time reading my rant.

Susie

ANSWER: Hi Susan,

With a severe ankle injury, there is soft tissue damage that can last for months to years or become an ongoing problem.  I have found that many with severe ankle sprains often have nerve damage.  The treatment that I use for the nerve damage is cryosurgery. See my site below.  The other important treatment that I would consider first is a custom orthotic device that is made by a podiatrist.

I believe if you have another MRI you will likely see some soft tissue damage.  If your pain worsens I would consider another MRI.

As I always suggest, consider a second opinion.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.



---------- FOLLOW-UP ----------

QUESTION: Hi Dr. KatZ:

Just a quick follow up I went to get a second he looked at the MRI that was originally taken a few months back and it was "inconclusive" according to the Dr. Something about excessive swelling??? It really wasn't that bad at that time and the swelling is a mute point now. He did mention to me about a deltoid ligament and a tibialis posterior tendon " I butched the spelling on them I think" that he didn't like the looks of but didn't go much further and didn't mention which one that he didn't like. My time in the 2 casts would have healed this?? He told me pretty much the same thing that you did but mentioned that if it persists that a new MRI would be in order. He gave me the name of 2 over the counter ankle support things to try. What is involved in a deltoid Ligament or that other tendon repair? Surgery immobilization or both? I really hope that the time I spent laid up was not wasted time. I really didn't like this man no bed side manor. I liked the first Dr. more then this guy It was like I was wasting his time he sort of gave me the creeps!

ANSWER: Hi Susan,

It is difficult to know what you may need without more detail.  However, if you have a problem with the posterior tibial tendon, you could benefit from a surgical procedure.  First I would try the ankle devices and have another MRI prior to any invasive procedures.

I would still seek some other opinions until you are comfortable.  I would make sure that your Dr. gives full explanations of your condition and options for treatment.  

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.


---------- FOLLOW-UP ----------

QUESTION: Once again Thank you so much you are very friendly and knowledgeable. I wish I lived in your part of the country I'd look you up in a heart beat. If this persists and there was the need for a surgical procedure what is a time frame for recovery/healing? real world time. I'm not a psalmist but I just have this gut feeling that there is an underlying issue here that was overlooked and this last guy I saw didn't want to give me the time of the day. after surgery is there immobilization involved again or just plain rest and therapy? I promise this is the last question/follow up. Thank you again for taking the time to answer my questions!!! :)


Answer
Hi Susan,

Feel free to ask as many questions as you like.

If surgery is required for a posterior tibial tendon rupture or worsening partial tear, there are many different approaches.  These include tendon debridement, tendon transfers, osteotomies (cutting and repositioning of bone) and joint fusions. These procedures can be fairly involved and do carry risks.  I would advise you to discuss the benefits vs. risks of all surgical options with your surgeon.

Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot - meaning you will be on crutches for two months.

As I said previously, make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.

Good Luck.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.