Question
Dr. Katz,

I am a 29 y/o female with a history of rt ankle fractures to my distal fibula.  I had two fx as a child and once as an adult (age 25).  Since the last fx I have had two full term pregnancies.  During each one, my ankle would feel weak and would 'give out' on me during normal daily activities.  I assumed it was due to putting on weight.  I gained 30 to 35 pounds with each pregnancy.  I am 5'9" and weigh 130lbs now.  I am now post partum 9 weeks and my ankle is still weak.

On 06/04/07, I was stepping up onto a boat and my rt ankle 'gave out' on me and I fell.  I just assumed it was a sprain.  There was no swelling but tenderness.  A few days later the tenderness was still there and was becoming a very dull ache.  A few days after that I still had the dull ache, throbbing and tingling in my last three toes.  I decided on 06/15/07 to go to my podiatrist.  I saw her with my last fx.  She did an x-ray.  She said that there was a 'line' in my fibula that looked like it was a possible stress fx and that the only way she would know for sure is to do a bone scan.  I am nursing right now and I didn't want to have the scan done bc she said if it was a stress fx that the treatment wouldn't change.  She put me in a walking boot (I was in a cast for 8 weeks and a walking boot for 4 weeks for the last fx). Since Friday, the tingling has moved into all the digits, the top/bottom of the foot and both sides of the ankle.  It is hard to get comfortable to rest at night (with or without the boot)bc of the sensation in my ankle/foot.

My question(s) are:  Is that just a normal healing sensation?  Could it be caused be the boot if it's not fitting properly?  Should I be worried that simply walking now can causes a fx in that foot?

I had a total thyroidectomy 12/07 due to a 4.5cm mass.  I am now on 100mcg of Synthroid daily, prenatal vitamins, calcium and Zoloft 100mg for PPD.

Any thoughts/advice you have is greatly appreciated.
Thanks,
Julie

Answer
Hi Julie,

I agree that a bone scan is not a good idea.  However, an MRI should be no problem and would not only look at the bone but also the soft tissues.  The sensation that you describe is nerve in origin.  After a foot or ankle sprain you may have stretched the nerves or inflammation may compress the nerves.  It is also possiblt that the boot is too tight or an improper fit.

I think you need to have a definite diagnosis.  Consider the MRI to see if there is a fracture.  If there is no fracture I would begin physical therapy to treat the area.

With chronic ankle sprains you need to consider wearing a brace after it heals or consider Prolotherapy.  These are injections that help strengthen the tendons and ligaments which are loose.

Hope that helps.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com

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