Persistent Pain After Ankle Injury: Seeking Answers in Rehabilitation

The left foot has re-injured an old injury, and despite experiencing soreness and sharp pain, there is still no resolution after seeking medical attention?

Two years ago in November, I twisted my left foot, resulting in bruising and swelling.
Instead of going to the hospital for an X-ray, I visited a traditional Chinese medicine clinic where the practitioner indicated that the bones in my foot were misaligned.
After receiving treatment, I gradually resumed physical activity, but I continued to experience pain and misalignment.
It wasn't until last summer that it seemed to have fully healed.
However, this year, after engaging in more intense activities like running, I noticed that the outer part of my foot (specifically the area resembling the cuboid bone) and my ankle would feel very sore.
I also observed that my left foot tends to make contact with the ground on the outer side before my right foot does.
Initially, I didn't think much of it, but over the past few months, I've experienced soreness even while walking, accompanied by occasional sharp pain.
Consequently, I consulted a rehabilitation specialist.

At the first clinic, an ultrasound scan was performed, and it was diagnosed that there seemed to be a fracture in the ankle area.
I underwent treatment with high-concentration glucose injections, but after one injection and a follow-up, I did not notice significant improvement.
The doctor mentioned that this treatment is not 100% effective, but most patients typically see noticeable improvement after the first injection.
However, given my diagnosis of benign joint hypermobility syndrome, the effectiveness might be slower or nonexistent.
The doctor also noted that my soreness could be exacerbated by weather changes, possibly indicating arthritis, and recommended physical rehabilitation, prescribing bone health capsules.
At the second physical rehabilitation clinic, I relayed the first clinic's diagnosis to the physician, who suggested that there might be calcification or bone spurs.
I received ultrasound therapy, passive traction, and electrical stimulation.
During the ultrasound treatment, the area diagnosed as fractured was particularly tender.
The physical therapist recommended that I get an X-ray at a hospital to check for bone spurs, as he would be unable to assist if that were the case.

I then went to the hospital for an X-ray.
Initially, I consulted a family medicine doctor, hoping they could recommend a suitable orthopedic or rehabilitation specialist.
The X-ray of my ankle was taken, and the family medicine doctor stated that the damage did not appear significant, nor was there evidence of severe arthritis.
However, he noted that the joint space was slightly narrowed and suggested that what the first clinic's ultrasound detected might be soft tissue-related.
He believed there was not a major bone issue and referred me to the rehabilitation department.

After reviewing the X-ray, the rehabilitation physician indicated that there were no significant problems and suggested that my foot issues were likely due to an old injury, which could cause soreness during times of physical weakness or poor weather.
He recommended training for proprioception and muscle endurance.
Despite this, I still experience soreness while walking, along with occasional sharp pain, primarily on the outer part of my foot rather than the ankle.
I would like to inquire whether the issue might be more related to the outer part of my foot rather than the ankle itself.
Thank you for your assistance.

Yan, 10~19 year old female. Ask Date: 2013/04/03

Dr. Chen Wayda reply Rehabilitation

It is difficult to assess without seeing the X-ray and the actual foot.
Please visit the outpatient clinic for evaluation.

Reply Date: 2013/04/03

More Info

Persistent pain after an ankle injury can be quite challenging, especially when it affects your daily activities and quality of life. Based on your description, it seems that you have been dealing with lingering discomfort in your left foot, particularly around the lateral aspect of the foot and ankle, following an injury that occurred over a year ago.
From your account, it appears that you initially sought treatment from a traditional practitioner who suggested that there was a misalignment in the bones. While manual therapy can sometimes provide relief, it is essential to have a comprehensive evaluation to rule out any underlying structural issues. The fact that you experienced bruising and swelling at the time of the injury indicates that there may have been soft tissue damage, which can sometimes lead to chronic pain if not adequately addressed.

The symptoms you describe—pain after vigorous activities, a sensation of the outer foot striking the ground first, and occasional sharp pain—could be indicative of several conditions. One possibility is that you may have developed a condition known as lateral ankle instability, which can occur after an ankle sprain. This condition can lead to chronic pain and discomfort, particularly during activities that place stress on the ankle.

Another potential issue could be related to the peroneal tendons, which run along the outside of the ankle and foot. If these tendons were strained during your initial injury, they could be contributing to your ongoing pain, especially with activities like running or jumping. Additionally, the presence of bone spurs or calcifications, as suggested by your physical therapist, could also be a factor, particularly if they are irritating surrounding soft tissues.

The fact that you have been diagnosed with benign joint hypermobility syndrome may also play a role in your symptoms. Individuals with this condition often have increased flexibility in their joints, which can lead to instability and pain, particularly in weight-bearing joints like the ankle. This hypermobility can make you more susceptible to injuries and may complicate recovery from previous injuries.

Regarding the treatments you have received, it is not uncommon for certain therapies, such as high-concentration glucose injections, to yield variable results. While some patients experience significant relief, others may not respond as well, particularly if there are underlying issues that have not been addressed. The ultrasound therapy and physical rehabilitation you have undergone are essential components of recovery, focusing on strengthening the muscles around the ankle and improving proprioception.

Given that your X-rays did not reveal significant bone issues, it may be beneficial to pursue further evaluation, such as an MRI, which can provide more detailed images of the soft tissues, including ligaments, tendons, and cartilage. This could help identify any tears or chronic changes that may not be visible on X-ray.

In terms of rehabilitation, focusing on strengthening exercises for the muscles around the ankle, as well as proprioceptive training, will be crucial. This can help improve stability and reduce the risk of re-injury. Additionally, consider working with a physical therapist who specializes in sports injuries or chronic pain management, as they can provide tailored exercises and modalities to address your specific needs.

In conclusion, while your ankle may not show significant structural damage, the ongoing pain and discomfort you experience could be related to soft tissue injuries, instability, or the effects of joint hypermobility. A comprehensive approach that includes further imaging, targeted rehabilitation, and possibly consultation with an orthopedic specialist may be necessary to fully address your concerns and facilitate recovery.

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