Ankle Pain and Recovery After a Fracture: A Patient's Journey

Pain below the medial malleolus, difficulty extending the foot arch, and pain behind the ankle?

Dear Doctor,
Hello, I sprained my right foot over two months ago, and at that time, I was diagnosed with a fracture of the fifth metatarsal.
I was treated with a splint but did not receive a cast.
The fracture site has healed, but I experience tearing pain in the sole of my foot, mild swelling and pain on the inner side of the ankle and behind the ankle, and difficulty with ankle inversion.
I have consulted both orthopedic and rehabilitation specialists, but they could not identify any issues.
Ultrasound treatment has resulted in swelling and pain throughout the ankle joint.

I have now noticed that my calcaneus seems to be slightly tilted inward.
When I attempt to manually reposition it, I find that the pain in the sole of my foot decreases, and the range of motion in my toes improves.
However, when I release my hand, it returns to its original position.
Sometimes, I feel the bones in my ankle joint moving.
I have seen several doctors in Tainan, but none have examined my foot; they simply stated there was no problem and advised me to exercise more.
However, Doctor, my foot is in an abnormal position, making it difficult to walk.
How am I supposed to exercise?
I have taken anti-inflammatories and muscle relaxants, but they have not been effective.
My greater concern is that if there are issues with my tendons or ligaments and they are not treated promptly, I may suffer long-term consequences.
Could you please advise me on what my issues might be and recommend a specialist in this area? Thank you very much.

Nìmíng, 50~59 year old female. Ask Date: 2015/11/27

Dr. Shi Guozheng reply Orthopedics

Toe fractures typically heal in about two months.
Pain in the sole and ankle may be related to the initial injury.
It is advisable to get an X-ray to check for any fractures in the ankle bones.
Consulting a specialist is recommended.

Reply Date: 2015/11/27

More Info

Dear Patient,
Thank you for sharing your concerns regarding your ankle pain and recovery after your recent fracture. It sounds like you have been through a challenging journey, and I appreciate your detailed description of your symptoms and the treatments you have undergone.

From what you have described, it appears that you may be experiencing a combination of issues related to your ankle injury. The fact that you have a history of a fifth metatarsal fracture and are now experiencing pain in the sole of your foot, along with mild swelling and difficulty with inversion of the ankle, suggests that there may be underlying complications that need to be addressed.

Possible Issues
1. Soft Tissue Injury: Even if the bone has healed, soft tissue injuries such as ligament sprains or tendonitis can cause significant pain and dysfunction. The ankle is a complex joint that relies on the integrity of ligaments and tendons for stability and movement. If these structures were injured during your initial trauma, they may not have healed properly, leading to ongoing pain and instability.

2. Joint Alignment: You mentioned that you noticed your calcaneus (heel bone) tilting inward and that manually adjusting it provided temporary relief. This could indicate a misalignment in the joint mechanics, which may be contributing to your pain. Ankle joint mechanics are crucial for proper function, and any misalignment can lead to abnormal stress on the surrounding tissues.

3. Tendinopathy: Pain in the ankle can also arise from tendinopathy, which is a condition characterized by degeneration of the tendon due to overuse or injury. This can occur in the tendons surrounding the ankle, particularly if they have been subjected to abnormal forces due to the injury.

4. Chronic Pain Syndrome: In some cases, patients develop chronic pain syndromes following an injury, where the pain persists long after the initial injury has healed. This can be due to changes in the nervous system that amplify pain signals.

Recommendations
1. Further Imaging: Since you have already undergone ultrasound without definitive findings, I would recommend considering an MRI of the ankle. An MRI can provide a more detailed view of the soft tissues, including ligaments, tendons, and cartilage, and can help identify any underlying issues that may not be visible on an X-ray or ultrasound.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can assess your ankle mechanics, provide targeted exercises to strengthen the surrounding muscles, and help improve your range of motion. They can also guide you on how to safely perform exercises without exacerbating your pain.

3. Consultation with a Specialist: If you have not already done so, consider seeking a consultation with a sports medicine physician or an orthopedic surgeon specializing in foot and ankle injuries. They can provide a comprehensive evaluation and may recommend additional treatments, such as corticosteroid injections or, in some cases, surgical intervention if there is significant structural damage.

4. Pain Management: Since you have tried non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants without relief, discussing alternative pain management strategies with your healthcare provider may be helpful. Options such as physical modalities (e.g., ultrasound, electrical stimulation) or even acupuncture may provide additional relief.

5. Activity Modification: While it is important to stay active, it may be necessary to modify your activities to avoid exacerbating your pain. Low-impact exercises such as swimming or cycling can help maintain fitness without putting excessive strain on your ankle.

Conclusion
Your concerns about potential tendon or ligament issues are valid, and it is crucial to address them to prevent long-term complications. I encourage you to seek further evaluation and treatment to ensure a comprehensive approach to your recovery. Remember, healing takes time, and it is essential to listen to your body throughout this process.

If you need assistance finding a specialist, I recommend checking with local orthopedic clinics or sports medicine centers in your area. They can provide the expertise needed to help you navigate your recovery effectively.

Wishing you the best in your recovery journey.

Sincerely,
Doctor Q&A Teams

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