Chronic Ankle Pain: Unhealed Fracture and Ligament Inflammation Issues

Non-union of fractures and chronic inflammation and pain of the lateral ankle ligaments?

Resume: Female / 25 years old
Duration of pain: From 17-18 years old to present
Visited orthopedic clinics / major hospitals
Diagnosis results:
1.
Unhealed closed fracture of the right lateral ankle
2.
Patellar malalignment + sports injury (volleyball)
3.
Sprain and tear of the lateral ankle ligaments
Attached is a link to an X-ray taken six years ago: https://goo.gl/xmwGq9 (no personal information, can be made public) (You can see a small fragment of bone possibly lodged in the lateral ligament position?) At that time, the doctor mentioned that it might have been a fracture that did not heal completely, but also advised against surgery to remove the small bone.

Now, whenever I walk too much, the posterior right ankle swells excessively, along with significant swelling and pain around the peroneal and posterior talofibular ligaments (the medical terms were looked up online, I apologize if I have offended any professional terminology).
Although the pain is not severe enough to prevent walking, I often experience instability and bumping into things while walking.
Additionally, I love playing volleyball and doing yoga, so this pain has caused me considerable distress and burden.

I have also undergone intensive rehabilitation at a physical therapy clinic for about six months to a year (frequency: about twice a week), but it seems to only alleviate the pain without leading to recovery; walking too much causes a relapse, and I experience daily swelling and inflammation.

I would like to ask the doctor:
1.
Is the accumulated ligament pain over the years related to the unhealed bone fragment?
2.
Are there any self-rehabilitation/exercise methods to improve the long-term inflammation of the ligaments?
3.
In yoga, there are kneeling and seated ankle compression poses (as shown in the image: https://goo.gl/ST7hrz) that cause extreme pain; should I avoid these movements?
4.
For issues like this, should I seek help from an orthopedic specialist, sports medicine specialist, or rehabilitation specialist?
Thank you, doctor, for taking the time to read my questions amidst your busy schedule, and I appreciate the excellent platform provided by Taiwan e-Hospital.

Niming, 20~29 year old female. Ask Date: 2017/09/25

Dr. Li Yongheng reply Orthopedics

Hello, your ankle pain may not be directly related to the closed fracture of the right lateral ankle, so removing the fragmented bone is unlikely to alleviate the pain.
Your ankle pain is associated with a tear of the lateral ankle ligaments and ankle joint instability.
Therefore, performing yoga poses that put pressure on the ankle (such as shown in the image: https://goo.gl/ST7hrz) can strain the ligaments and exacerbate the pain, so it is advisable to avoid this movement.
I recommend that you visit a subspecialty in orthopedics: the sports medicine clinic for an evaluation, including stress views and MRI, to assess whether lateral ligament reconstruction surgery is necessary.
Wishing you a speedy recovery.

Reply Date: 2017/09/25

More Info

Chronic ankle pain, especially following an unhealed fracture and ligament inflammation, can be a complex issue that significantly impacts daily activities and quality of life. Based on your description, it seems that you have been dealing with persistent pain and instability in your right ankle for several years, stemming from a previous injury that has not fully healed. Let's address your questions one by one.

1. Is the accumulated ligament pain related to the unhealed fragment?
Yes, it is quite possible that the unhealed bone fragment is contributing to your ongoing ligament pain. When a fracture does not heal properly, it can lead to abnormal mechanics in the joint, which may cause increased stress on the surrounding ligaments. This can result in chronic inflammation and pain. The presence of a loose bone fragment can also irritate the ligaments and surrounding soft tissues, leading to further complications such as tendonitis or synovitis.

2. Are there self-rehabilitation or exercise methods to improve chronic ligament inflammation?
While self-rehabilitation can be beneficial, it is crucial to approach it cautiously, especially given your history of ankle issues. Here are some general strategies you might consider:
- Strengthening Exercises: Focus on exercises that strengthen the muscles around the ankle, such as calf raises, ankle circles, and resistance band exercises. Stronger muscles can provide better support to the joint.

- Balance Training: Incorporate balance exercises, such as standing on one leg or using a balance board, to improve proprioception and stability.

- Stretching: Gentle stretching of the calf and ankle muscles can help maintain flexibility and reduce tension in the ligaments.

- Low-Impact Activities: Engage in low-impact activities like swimming or cycling to maintain fitness without putting excessive strain on your ankle.

3. Should you avoid certain yoga poses that cause pain?
Yes, if specific yoga poses, such as kneeling or sitting on your ankle, cause significant pain, it is advisable to avoid them. Pain is a signal from your body indicating that something is not right. Continuing to perform movements that exacerbate your pain can lead to further injury or chronic issues. Consider modifying your practice to include poses that do not put pressure on your ankle, and consult with a yoga instructor who has experience with injuries.

4. Which specialist should you consult?
Given your situation, it would be beneficial to consult with an orthopedic specialist who has experience in sports medicine or a rehabilitation physician. An orthopedic doctor can evaluate the status of your ankle, possibly through imaging studies like an MRI, to assess the unhealed fracture and any associated soft tissue injuries. A sports medicine specialist can provide insights into managing your condition while allowing you to continue engaging in activities you enjoy, such as volleyball and yoga. Additionally, a physical therapist can help design a tailored rehabilitation program to address your specific needs.

In conclusion, chronic ankle pain following an unhealed fracture and ligament issues can be challenging. It is essential to seek appropriate medical advice and consider a multidisciplinary approach that includes orthopedic evaluation, physical therapy, and possibly modifications to your activities. With the right care and rehabilitation strategies, you may find relief from your symptoms and improve your ankle function over time.

Similar Q&A

Understanding Ankle Pain: Causes, Diagnosis, and Treatment Options

I previously injured my ankle from dancing and playing basketball. Prolonged standing or walking causes significant pain. The doctor mentioned that overuse has led to joint wear, resembling that of someone in their 40s. Since I work in the kitchen during my military service, I ha...

Dr. Shi Guozheng reply Orthopedics
Ankle joint injuries typically affect the ligaments surrounding the joint, which are present on both the medial and lateral sides. The most commonly injured ligament is the anterior talofibular ligament, often damaged during activities such as basketball when the ankle is subject...

Understanding Ankle Tendon and Ligament Issues: Recovery and Chronic Inflammation

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 complet...

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.

Persistent Ankle Pain After Surgery: Unremoved Screw and Complications

Hello Doctor, earlier this year I had surgery to remove three fixation screws from an ankle fracture that occurred a year ago. One of the screws broke and could not be removed, and it is currently lodged in the bone. Since then, my foot has started to hurt. The doctor mentioned t...

Dr. Hong Ximing reply Orthopedics
If an ankle fracture has healed, it should not be related to the presence of screws or sutures. Consideration should be given to the condition of the ligaments after the injury or the possibility of post-traumatic arthritis. Please consult your attending physician for further det...

Managing Chronic Ankle Ligament Pain: Next Steps for Recovery

Hello, I sustained a tear in my ankle ligaments due to an accident last July. I started rehabilitation in September and also received glucose injections, but I have been experiencing pain ever since. I have only been doing the exercises taught by my physical therapist. This year,...

Dr. Shi Guozheng reply Orthopedics
Ligament sprains typically require conservative treatment and rarely necessitate surgery. Continuing rehabilitation or wearing an ankle brace for protection is advisable. As long as there is no instability, recovery will gradually occur.