Chronic Ankle Pain: Seeking Solutions After 10 Years of Discomfort

I have had an ankle injury for 10 years and don't know how to heal it?

Hello Dr.
Chen: I live in Yilan.
I injured my left ankle while playing basketball in high school.
I thought it would heal naturally like usual, but over time, there has been no improvement.
It becomes very uncomfortable whenever I twist it, especially when going down stairs, and I often experience soreness in my calf as well.
The prolonged issue is due to my inability to find time to see a doctor.
My left pelvis shifts with large movements but does not cause pain; the doctor said this is "snapping hip syndrome" and it does not have an impact.
However, a traditional Chinese medicine practitioner mentioned that this affects the recovery of my ankle.
It seems I have a leg length discrepancy, but after an X-ray, there was no issue found.
After my military service, I went to the hospital for X-rays and ultrasounds focused on my left ankle, but the orthopedic doctor said there were no bone problems, just chronic inflammation, specifically Achilles tendinitis.
He recommended physical therapy, but I have been doing it for 2-3 years with no effect.
I took advice to try acupuncture and massage for over a year, but that has not helped either.
Now, I am unsure which doctor can truly identify my problem and provide effective solutions.
I even considered surgery, but the doctor advised against it, stating the chances of success are low.
Dr.
Chen, what should I do? Some have suggested getting an MRI to accurately diagnose the issue, but I am unsure how to proceed, and the cost is quite high.
If I do go through with it, will it really identify the cause, and how can I then address my left ankle issue? Please help me, Dr.
Wang.
Thank you!

A-Hong, 20~29 year old female. Ask Date: 2015/11/17

Dr. Chen Wayda reply Rehabilitation

Go to another large hospital for examination.

Reply Date: 2015/11/17

More Info

Chronic ankle pain can be a frustrating and debilitating condition, especially when it has persisted for a decade. Your experience of ankle discomfort following a basketball injury is not uncommon, and it highlights the complexities of musculoskeletal injuries and their long-term effects.
Firstly, it’s essential to understand that chronic ankle pain can arise from various factors, including ligamentous injuries, tendinopathy (such as Achilles tendinitis), joint instability, and even referred pain from other areas of the body. The fact that you have experienced persistent pain and discomfort, particularly when navigating stairs or after twisting your ankle, suggests that there may be underlying issues that have not been adequately addressed.

You mentioned that orthopedic evaluations have indicated no significant bone issues, but rather chronic inflammation. This is a critical point, as chronic inflammation can lead to ongoing pain and dysfunction. The recommendation for rehabilitation is a common approach, but it seems that your experience with physical therapy has not yielded the desired results. This can happen for various reasons, including the type of rehabilitation exercises prescribed, the frequency of sessions, or even the specific techniques used by the therapist.

In your case, it may be beneficial to consider a multidisciplinary approach. Here are some potential steps you could take:
1. Re-evaluate Physical Therapy: If you have not seen improvement after 2-3 years of physical therapy, it may be time to seek a different therapist or a specialized rehabilitation program. Look for a therapist who has experience with sports injuries and chronic pain management. They may employ different modalities, such as manual therapy, neuromuscular re-education, or specific strengthening exercises tailored to your condition.

2. Consult a Sports Medicine Specialist: A sports medicine physician can provide a comprehensive evaluation of your ankle. They may suggest advanced imaging studies, such as an MRI, which can help identify soft tissue injuries, including ligament tears, tendon issues, or cartilage damage that X-rays might miss. While MRIs can be costly, they can provide valuable insights that guide treatment decisions.

3. Consider Alternative Therapies: You mentioned trying acupuncture and massage therapy without success. However, some patients find relief through other modalities, such as dry needling, chiropractic care, or even specialized techniques like Graston or ASTYM therapy, which focus on soft tissue mobilization.

4. Explore Orthotic Solutions: Sometimes, chronic ankle pain can be alleviated with the use of custom orthotics or supportive footwear. A podiatrist can assess your foot mechanics and recommend appropriate orthotic devices that may help stabilize your ankle and reduce pain during activities.

5. Surgical Consultation: While you noted that surgery was not recommended, it may be worthwhile to seek a second opinion from an orthopedic surgeon who specializes in foot and ankle conditions. They can evaluate whether there are any surgical options that could provide relief, especially if conservative treatments have failed.

6. Lifestyle Modifications: Incorporating low-impact activities, such as swimming or cycling, can help maintain fitness without exacerbating ankle pain. Additionally, focusing on maintaining a healthy weight can reduce stress on your joints.

7. Pain Management Strategies: Discuss with your healthcare provider about pain management options, including medications or injections that may help reduce inflammation and pain in the short term.

In conclusion, chronic ankle pain can be complex and multifactorial. It is crucial to take a proactive approach by seeking further evaluations and considering a multidisciplinary treatment plan. While it may take time to find the right combination of therapies, persistence is key. Engaging with healthcare professionals who understand the nuances of chronic pain and sports injuries can significantly improve your quality of life and potentially lead to a resolution of your symptoms.

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