Ankle Tendon and Ligament Issues: Recovery and Chronic Inflammation

Regarding issues with ankle tendons and ligaments?

Doctor, I injured my ankle about six months ago, and sometimes it still feels uncomfortable due to inflammation.
Initially, the injury was primarily to the anterior talofibular ligament (lateral side) of my right ankle, and the doctor at that time determined it was nearly completely torn.
After six months, the doctor said it has mostly healed but is loose.
I would like to ask:
1.
I recently had a follow-up appointment and an ultrasound, and the doctor said the ligament has healed sufficiently, but inflammation occurs because the tendon is unstable, so I need to strengthen my muscles for support.
Does this count as ligament inflammation?
2.
Would you consider this a case of habitual (chronic) inflammation?
3.
I have been trying to rehabilitate by jogging, but sometimes when my heel strikes the ground, I experience a sudden pain in that area.
What could be the reason for this?
4.
When I move my ankle up and down, there is sometimes a cracking sound.
Is this due to the ligament or the tendon? Since it has been over six months since my ligament injury, the clinic doctor believes I do not need further treatment and can rehabilitate at home, but my ankle still feels uncomfortable...
Thank you for your assistance, doctor.

BEAR, 20~29 year old female. Ask Date: 2017/05/10

Dr. Shi Guozheng reply Orthopedics

1.
It is not ligament inflammation; it is instability.

2.
It is not considered a tear.

3.
Sometimes it may feel strained.

4.
Tendon.

5.
Continue with rehabilitation and also wear an ankle brace for a period of time.

Reply Date: 2017/05/10

More Info

Understanding ankle tendon and ligament issues, especially after a significant injury, can be complex. Your situation, involving a near-complete tear of the anterior talofibular ligament (ATFL) and ongoing discomfort after six months, raises several important points regarding recovery, inflammation, and rehabilitation.

1. Is the inflammation due to ligament issues?
It sounds like your doctor has indicated that the ligament has healed but may not be as stable as it once was. In this context, the inflammation you are experiencing could indeed be related to the instability of the ligament. When ligaments are not fully stable, they can lead to compensatory movements in the surrounding muscles and tendons, which may cause irritation and inflammation. This is often referred to as "reactive inflammation," where the body responds to instability or abnormal movement patterns. Strengthening the muscles around the ankle can help provide better support and stability, potentially reducing inflammation.

2. Is this chronic inflammation?
Given that you have been experiencing discomfort for six months, it is possible that you are dealing with chronic inflammation. Chronic inflammation can occur when the body continues to respond to an injury or instability, leading to persistent symptoms. In your case, if the inflammation has not resolved and continues to cause discomfort, it may be classified as chronic. This is often characterized by ongoing pain, swelling, and sometimes stiffness in the affected area.

3. Pain during running and its causes:
The sudden pain you experience in your heel when running could be due to several factors. It may be related to improper biomechanics resulting from the ankle instability, which can place additional stress on the heel and surrounding structures. It's also possible that you could be experiencing issues such as plantar fasciitis, Achilles tendinopathy, or even referred pain from the ankle itself. If the pain persists, it would be wise to consult a physical therapist or a sports medicine specialist who can assess your running mechanics and provide targeted rehabilitation exercises.

4. The "cracking" sound during ankle movement:
The "kaka" sound you hear when moving your ankle could be due to several reasons. It might be related to tendons snapping over bony prominences or ligaments moving over the joint surfaces. This is often benign, especially if there is no associated pain. However, if you notice that the sound is accompanied by discomfort or instability, it may warrant further investigation. It could indicate that the ligaments or tendons are not gliding smoothly due to scar tissue or inflammation.

In summary, your ongoing discomfort and the symptoms you describe suggest that while your ligament may have healed, the surrounding structures may still be compensating for the instability. Strengthening exercises, proper rehabilitation, and possibly modifying your activities (like running) could be beneficial. It’s essential to work closely with your healthcare provider or a physical therapist to develop a tailored rehabilitation plan that addresses your specific needs and helps you regain full function of your ankle. If symptoms persist or worsen, further imaging or intervention may be necessary to rule out any underlying issues.

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