Question
Dr. Katz,

I have a seemingly uncommon problem with my right ankle that has been a nightmare for years and am hoping you can help.

I am 24 years old, in great shape, and exercise very regularly.  However, I have recurring right ankle pain whenever I抦 on my feet for extended periods of time.  It does not occur after running for long lengths or sports, but only after walking or standing for a long period of time.  The pain is on the top/outside of my ankle and is consistent with a severe ankle sprain.  It also renders my ankle incredibly stiff with no range of motion.  I first started having problems about 6 years ago when I got a summer job working on my feet all day in a factory.  All day when I stood, the pain was not too bad, but as soon as I went home and started resting, the pain would come in waves/spasms, prevented me from putting ANY weight on it, and only affected my right ankle.  Anti-inflammatories were the only thing that sometimes helped (pain-killers did not).  The pain would run throughout the night and then for a couple hours during the morning.  After a couple hours on my feet, the pain would subside卋ut then come back again later that night.  I finally had to quit the job as the nightly pain was excruciating.  Over the next couple years (and especially during a summer landscaping job), the pain would come back for a day, go back to 100%, and then come back again ?always after extended amounts of time on my feet.  For four years I have not had too much trouble with it, but now I have a job that requires me to be on my feet for a long time a couple times a month.  I had thought the problem was gone, but it抯 back again and with the same exact symptoms and only on my right ankle.  Each time, the pain is unbearable that night and then completely gone by midday the following day.

I have been in to see a doctor, and 2 specialists.  I have taken X-Rays and MRIs (all during the first 2 years).  Every time, the doctor/specialist was surprised by the stiffness, but said that I merely had a severe ankle sprain and that they didn抰 see anything else wrong.  Their explanation was that the ankle had never truly healed, but that really makes no sense now because it had been almost 4 years without a problem and is now back again.  I was wondering if you had ever encountered any similar cases or could shed any light on a possible explanation or diagnosis.

Thank you in advance.

Justin
Michigan  

Answer
Hi Justin,

Some possible causes may include tarsal coalition which is fusion of some of the foot bones and often related to that is peroneal spasm which is pain spasm of the tendons behind the ankle.  Perhaps you have some bones that have fused are were missed on MRI and x-ray.  

The other common problem associated with ankle sprain is damage or entrapement of the sural nerve which runs behind the ankle.  I see patients with ankle injuries and they commonly have some nerve problem.  I will typically do a procedure known as Cryosurgery, see my site below.

You may need to see a more astute Dr.  I would suggest some other opinions.

See the article below:

http://thetampapodiatrist.com/document_disorders.cfm?id=248

Sincerely,

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


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