Persistent Ankle and Calf Swelling: Unraveling the Mystery of Pain

Abnormal swelling in the posterior lower leg near the ankle?

This issue has been ongoing for six months.
Initially, there was a lump the size of a five-dollar coin on the inner side of my ankle, which only hurt when pressed.
Over time, it gradually enlarged, affecting the entire ankle, and the lump became more palpable.
I visited a traditional Chinese medicine clinic, where the practitioner suggested it was due to a sprained ankle, but it still hasn't improved.
I also tried acupuncture; the doctor mentioned it was due to poor circulation of qi and blood.
After the treatment, I felt somewhat better, and there was noticeable reduction in swelling around the ankle.
Later, I consulted a traditional Chinese medicine doctor who said it was an old injury, resulting in tissue fibrosis.
However, the lump has slowly migrated upwards, now located on the back side of my calf near the ankle.
There is a clearly visible red circle beneath the calf muscle.
I underwent X-rays, ultrasound, and MRI at Chang Gung Memorial Hospital, but no issues were detected.
However, whenever I expose it to hot water, the lump becomes more pronounced, resembling a thick band extending horizontally from the calf to the inner side of the ankle.
Even when wearing pants, the redness is noticeable, and pressing it causes pain.
I have tried muscle pain relief ointments and adhesive patches, but nothing seems to help.
I have undergone numerous tests, yet the underlying problem remains elusive.
I sincerely request the doctor's guidance.
Thank you!

Ms. Huang, 20~29 year old female. Ask Date: 2017/03/08

Dr. Shi Guozheng reply Orthopedics

If all the detailed examinations have been conducted and a diagnosis still cannot be determined, then it is advisable to visit a medical center to consult another physician for a reevaluation.

Reply Date: 2017/03/08

More Info

Persistent ankle and calf swelling can be a perplexing issue, especially when it has been ongoing for six months without a clear diagnosis. Based on your description, it seems that you have experienced a progression of symptoms starting from a small painful lump on the inner side of your ankle, which has since enlarged and migrated up to your calf. You have sought various treatments, including traditional Chinese medicine, acupuncture, and imaging studies like X-rays, ultrasounds, and MRIs, all of which have not provided a definitive explanation for your symptoms.

There are several potential causes for persistent swelling and pain in the ankle and calf area. Here are some possibilities to consider:
1. Chronic Inflammation: The initial injury you mentioned could have led to chronic inflammation in the ankle joint or surrounding tissues. This can result in swelling and pain that persists long after the initial injury has healed. Conditions such as tendinitis or bursitis could be at play here.

2. Lymphatic Issues: Swelling can also be a result of lymphatic obstruction or lymphedema, where lymph fluid accumulates due to impaired drainage. This can cause swelling that may not be easily identifiable through standard imaging techniques.

3. Venous Insufficiency: Chronic venous insufficiency occurs when the veins in the legs do not efficiently return blood to the heart, leading to swelling, pain, and sometimes skin changes. This condition can be exacerbated by prolonged standing or sitting.

4. Fibrosis: As your traditional Chinese medicine practitioner suggested, fibrosis or the formation of scar tissue from a previous injury can lead to localized swelling and discomfort. This can occur even if the initial injury was minor.

5. Neuromuscular Issues: Sometimes, nerve compression or irritation can lead to swelling and pain in the lower extremities. Conditions such as sciatica or peripheral neuropathy could manifest in this way.

6. Infection or Inflammatory Conditions: While imaging studies may not show acute infections, chronic infections or inflammatory conditions such as rheumatoid arthritis or gout could lead to persistent swelling and pain.

7. Allergic Reactions or Dermatitis: The redness and swelling you describe could also be a reaction to something in your environment, such as a topical medication, or even an allergic reaction to clothing materials.

Given that you have already undergone extensive testing without a clear diagnosis, it may be beneficial to seek a second opinion from a specialist, such as a rheumatologist or a vascular surgeon. They may provide additional insights or tests that could help identify underlying issues that have not yet been considered.

In the meantime, managing your symptoms with conservative measures such as elevation of the affected limb, compression garments, and gentle exercises may help alleviate some of the swelling and discomfort. Additionally, keeping a detailed diary of your symptoms, including any triggers or patterns you notice, can be helpful for your healthcare provider in diagnosing your condition.

It is essential to continue advocating for your health and seeking answers, as persistent symptoms can significantly impact your quality of life. Don't hesitate to ask your healthcare providers about potential referrals or additional tests that could shed light on your condition.

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