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ankle pain for 4 months after injury
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singingfrizzle posted:
My daughter injured her ankle in dance class in April. She said she felt a 'pop' after coming down out of a leap. We took her for xrays & MRI. it showed nothing. We did 24 rounds of physical therapy. Still pain. We went to a podiatrist & he put in her in a boot. Still pain. Had another MRI done and put on crutches for 4 weeks. Still pain. Nobody can seem to figure out what's going on, but yet she's still in pain. I'm desperate to get answers for her! Please help!
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annette030 responded:
How old is she? At what level does she dance? Does she still want to dance? What can she do before triggering pain at this point?

Do the xrays and MRIs show anything at all? What may not show on these films and still be damaged?

Take care, Annette
 
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Peter Abaci, MD responded:
When significant pain like this persists after an injury in the absence of noteworthy orthopedic findings, then that makes me suspicious of a nerve pain problem. Nerve pain, also known as neuropathic pain, can sometimes accompany sprains and strains and be a source of continued symptoms, even after the soft tissue injury heals. In some cases, it may be difficult to pick up the presence of nerve irritation, but clinical symptoms may include burning or sharp pain, sensory changes, color changes, temperature changes, and swelling.

Ask your doctors if something like this could be taking place and contributing to your daughter's delayed recovery. If so, then staying off of the foot with crutches or immobilizing it in a boot may not help but could slow recovery. Restoring function is critical to recovering from any injury.

Feel free to follow up with us on how things are going.
 
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singingfrizzle replied to annette030's response:
She is 18 & yes she does still want to dance. Sorry, I should have stated that MRI's & Xrays show nothing. She actually says it hurts MORE to sit down with her foot than to be on it. Strange, but that's the case.
 
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singingfrizzle replied to Peter Abaci, MD's response:
Thank you for your reply. Interesting you should say this. The podiatrist that we finally took her to (after all the Orthos said there was nothing wrong) said that it might be nerve damage & to take her to a neurologist. After examining her, she said that she showed no weakness, which would indicate nerve damage. We are scheduled for a nerve conduction test this week. But she feels like it is pointless.

There hasn't been any significant swelling since she injured it at all. They do say that there is a small ganglion cyst present, but that it's not contributing to the problem. But I am still wondering about that. It's in a completely different area than where her pain is though. So maybe it's not contributing.

We will see what the nerve test shows us, as that's about our only answer as we can see it now.

We are going for a 2nd opinion with another podiatrist at the request of the first one today. I'll keep you posted.
 
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annette030 replied to singingfrizzle's response:
I had a swollen knee a couple of times and the orthopedist I saw told me that even if the MRI was negative, there was one ligament that it would not show anyway, an exploratory surgery would be needed to see that ligament. Have the doctors said anything about a structure in the ankle that is like that?

Could she have anything wrong that just happened at the same time as the injury, but the pain might be totally unrelated?

I would suggest she see another orthopedic doctor and go in without telling him about the injury, just tell him about the pain at first anyway. She might let him know that she dances, see if he comes up with anything else. Please let us know what happens.

Take care, Annette
 
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singingfrizzle replied to annette030's response:
Her insurance is very limited. We've seen 2 different ortho Drs & nothing. But we did go to the 2nd opinion podiatrist yesterday. She gave her the anti-inflammatory gel, suggested that she do a little more physical therapy & then come back & re-visit her in a month. Possibly another injection. She said sometimes the first one doesn't do a lot, but the 2nd one really helps. She said she's not giving up until we find out what stops the pain. So was happy to hear that. BUT.... I won't discount what you said. We'll see how this all works & then find out about possibly another ortho. Have the nerve testing tomorrow. She thought that might be a possibility as well. So we'll see how that comes out. Thanks for your reply!
 
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Peter Abaci, MD replied to singingfrizzle's response:
I just wanted to add that the nerve test can provide helpful information in some cases, but your daughter can still be having nerve pain even if the test is negative. A person can have really significant pain with normal results, so it is important to be careful about how the information gets interpreted.
 
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annette030 replied to singingfrizzle's response:
We actually know very little about pain. There is no test that will show just pain, or how much or how little one is having. Only the patient knows what their pain level is. Never stop believing your daughter!

Can you put her on your health insurance policy? Or is that the one you are talking about?

Plantar fasciitis can cause foot pain that is not due to an injury. I thought of it yesterday, but did not go on the computer at all.

Is her pain in her ankle now or her foot? I think podiatrists do ankles too, or do they just do feet? I think I am confused about where her pain is because you mentioned it in your post to me three days ago. You said "It hurts MORE to sit down with her foot than be on it." Help???

Take care, Annette
 
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singingfrizzle replied to annette030's response:
Ok, so had the nerve test & as you said, Dr. Abaci, the test was negative. The neuro didn't really think it was nerve damage, as she had no weakness in her foot/ ankle.

@Annette, she is on a Medicaid policy until she's 19. The copays & benefits are actually better on that, but limited on Drs. The pain is actually on the side of her ankle, the top of her foot & sometimes up her shin. And yes, podiatrists do treat ankles & feet. We've had more success with him than the MD's & Orthos that we've seen. The one we saw for the 2nd opinion said she's not going to give up until we get this figured out. She also said it is somewhat normal for her to have more pain once she sits down, because everything tends to 'relax' when she sits down, therefore the pain. (in a nutshell)

So any more ideas would be greatly appreciated. Thanks so much for your help!
 
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An_247655 replied to singingfrizzle's response:
Try googling Peroneal Tendons and look up the images of where these tendons run. They hold the muscle on the shin and go round the outside of the ankle and down the foot. I'm in the EXACT same position as your daughter (I'm 20). I sprained my ankle playing soccer in April. Couldn't walk and was in a boot for weeks. I had a MRI scan which shows fluid and torn ATFL (ligament). The doctor said I should be fine after resting but here we are and I still have so much pain. I had arthroscopy surgery 5 weeks ago to remove scar tissue, I have recovered from that but still have the pain from before, exact same symptoms and running is the worst thing ever. After googling I believe I have damage my peroneal tendons. I have the Pain round the outside of my ankle and down the foot. Mine also 'sublux' and pop out of place. I see the doctor next week and going to suggest this injury. According to the Internet it's commonly missed. They can be torn or have tendinitis. Let me know what you think!!
 
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annette030 replied to singingfrizzle's response:
Thanks for responding. Now I have a better idea where the pain is. A member here swears by podiatrists, I have not been to one myself. I hope the new one figures things out soon.

Take care, Annette
 
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borgst replied to singingfrizzle's response:


It's possible your daughter is suffering from a condition called Complex Regional Pain Syndrome (CRPS). If so, the sooner she is diagnosed the better the chances for recovery.

Good luck - Barbara


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