Ankle Injuries: When It’s Not Just a Sprain

It looks like a sprain, but it doesn't seem to be one?

I injured myself while playing volleyball when I jumped and landed, putting all my body weight on my left foot.
I was in a squatting position with my foot close to the ground, so it shouldn't be considered a sprain.
Then I heard two popping sounds.
At first, I thought it was just a minor sprain, but after taking a few steps, the pain became unbearable.
I couldn't even support myself and had to hop around.
That day, I got an X-ray, and the doctor said there were no issues with the bones.
I later sought further evaluation, and for over two months now, my symptoms have remained the same.
I can walk normally, but suddenly stepping into a hole or straightening my left leg causes a sensation like pressure on a nerve.
I'm unsure what this issue might be.
I feel like I haven't communicated my condition clearly during my evaluations, which might be why I haven't received a proper diagnosis.
The pain is located deep below the ankle (I describe it as deep because I don't feel anything when I press with my hand), and I also experience pain when I push up on my four toes.
I'm wondering if the doctor knows what I might have injured or what kind of examination I should undergo.
Thank you.

Chengze, 20~29 year old female. Ask Date: 2015/09/23

Dr. Chen Wayda reply Rehabilitation

Perform an ultrasound examination.

Reply Date: 2015/09/23

More Info

Based on your description of the injury sustained while playing volleyball, it sounds like you may be dealing with more than just a simple ankle sprain. The fact that you heard a popping sound ("2趴趴兩聲") during the incident and are experiencing persistent pain, particularly when putting weight on your left foot or when your ankle is in certain positions, suggests that there could be a more significant injury involved.

Possible Injuries
1. Ligament Injury: While you mentioned that the X-ray showed no fractures, it's possible that you have sustained a ligament injury, such as a sprain or tear. The ligaments around the ankle, particularly the lateral ligaments, are commonly injured in sports. A complete tear could lead to instability and pain, especially during activities that require sudden movements or changes in direction.

2. Tendon Injury: The popping sound you heard could also indicate a possible tendon injury, such as an Achilles tendon rupture or a peroneal tendon injury. These tendons are crucial for ankle stability and mobility, and injuries can lead to significant pain and dysfunction.

3. Nerve Compression: The sensation of "pressing on a nerve" that you described could be indicative of nerve compression or irritation, possibly due to swelling or inflammation in the ankle region. This can occur after an injury and may lead to symptoms like tingling, numbness, or sharp pain.

4. Cartilage Damage: Although less common, damage to the cartilage in the ankle joint can occur, especially if there was a significant force applied during the injury. This could lead to joint pain and instability.

Recommended Actions
1. Further Imaging: Since the initial X-ray did not reveal any fractures, it may be beneficial to pursue further imaging, such as an MRI. An MRI can provide detailed images of soft tissues, including ligaments, tendons, and cartilage, and can help identify any tears or other injuries that may not be visible on an X-ray.

2. Physical Examination: A thorough physical examination by an orthopedic specialist or a sports medicine physician is crucial. They can perform specific tests to assess the stability of the ankle and the integrity of the ligaments and tendons.

3. Rest and Rehabilitation: In the meantime, it is essential to rest the ankle and avoid activities that exacerbate the pain. Ice therapy can help reduce swelling, and over-the-counter pain medications may alleviate discomfort. Once the acute pain subsides, a structured rehabilitation program focusing on strengthening and stabilizing the ankle may be beneficial.

4. Consideration of a Brace: Depending on the assessment, using an ankle brace or support may provide additional stability during the healing process.

5. Follow-Up: Regular follow-up with your healthcare provider is important to monitor your recovery and adjust your treatment plan as necessary.

Conclusion
In summary, your symptoms suggest that there may be more than just a simple sprain at play. Given the history of a popping sound and ongoing pain, further evaluation through imaging and a comprehensive physical examination is warranted. Early intervention and appropriate rehabilitation can significantly improve your recovery and help prevent long-term complications. If you continue to experience pain or instability, do not hesitate to seek further medical advice.

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