Chronic Ankle Pain after Two Injuries

Posted by w9awx @w9awx, Apr 17 2:01pm

I have had chronic ankle pain and weakness since I rolled my ankle bad walking my dog. My dog felt so bad when I went down. This was June of 2023. Have been in a CAM boot on and off since then, last time was from January to April of this year after I fell when my ankle gave out. Saw my Orthopedic surgeon who is concerned about the time I was in the boot causing nerve damage . Pain at times is off the chart if I am walking on it for any time with or without the boot.
I've had physical therapy, 2 cortisone shots, 2 MRI, 4 X-rays, and an ultrasound, I saw a Neurologist this week. He has ordered me a nerve blocker procedure to temporarily try and remove the pain. Hoping it will either definitively show nerve issues or that it is some other physical issue. Anyone have a nerve blocker and found it was something other than nerve issues?

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dlydailyhope | @dlydailyhope | Apr 18 6:19am

@w9awx
Did your neurologist suggest doing an EMG/nerve conduction study to determine if nerves are damaged?

Did they mention getting a small fiber neuropathy skin punch biopsy?

I’m not sure wearing the boot would cause nerve damage but it could weaken muscles.

I wonder if you injured a nerve(s) when you first rolled your ankle really bad. That could have hyper-stretched tendons/ligaments and nerves to cause injury. Did you break anything when you first injured it? Did you need surgery at the time?

I rolled my foot/ankle while walking (foot rolled off the edge of a path) but then fell forward and broke my foot (5th metatarsal). My orthopedic doctor had me in a boot for a while but I did not tear anything, only sprained it along with the broken bone. Only get some arthritis pain now when it rains.

When my neurologist did my EMG recently, he found I had an injured nerve in my calf (plus I already knew I had small fiber neuropathy from a biopsy years ago). Years ago I was dancing and my foot slipped sideways and I felt a crunch in my knee. I could not walk for a long time and injured some soft tissues which were really inflamed. I got a cortisone injection and they did surgery to remove plica tissue. No one ever told me until recently that my nerve was injured even though I had multiple EMGs over time (some doctors are better than others when doing EMGs so you may get different results). I have some permanent injury in that nerve from that one slip and I get some pain/numbness/weakness in that calf, depending on what I do.

Have you tried topical nerve pain creams like capsaicin or Salonpas lidocaine patches for temporary relief? Do you have inflammation and have you tried Voltaren gel or icing? Do they suggest wrapping your foot/ankle with ace bandages? Do you elevate your foot or try compression socks?

w9awx | @w9awx | Apr 18 7:01am

In reply to @dlydailyhope "@w9awx Did your neurologist suggest doing an EMG/nerve conduction study to determine if nerves are damaged?..." + (show)

My orthopedic surgeon had me do a EMG last week for the neurologist to see the results. They found several defects in the signal to narrow down where the issue is. Nerve blocker will be to see if there are more underlying issues besides the nerve issues or if it just nerve damage causing the severe pain in my ankle. I’ve done the ice, rest, elevation with no success. I’ve done therapy to try and strengthen the muscles and tendons. Did the lidocaine patches and 2 cortisone shots into the tendon.

JulesE | @julese | Apr 21 1:48pm

By saying you’ve done therapy does that mean you stopped doing it? Did they provide you with a home exercise program to continue with afterward? This kind of ankle injury that is not fracture related but soft tissue take longer to heal just by the nature of its location. You still want to use it everyday but it’s not really at 100% yet but you persist. The boot was to help the soft tissue rest and repair. Now is the hard part and it’s all on you. By continuing do the prescribed exercise hopefully over time you will become stronger and pain will decrease as your ankle heals. But it takes time and perseverance. Good luck and stick with it.

w9awx | @w9awx | Apr 21 3:15pm

In reply to @julese "By saying you’ve done therapy does that mean you stopped doing it? Did they provide you..." + (show)

Been doing exercises at home and at work.

Jennifer, Volunteer Mentor | @jenniferhunter | Apr 21 10:06pm

@w9awx Hello and welcome to Connect. I've learned some things about an injury from a rolled ankle. I had a bad fracture that also included a sprain. When you recover from an injury like this, you start compensating and walking differently. I had a weak side and a stronger side of my leg. All of that was putting too much pressure on the injured side as the other side overpowered it. That kept me in a constant pain from the sprain. I also had scar tissue from the surgeries for the injury and the injury because it was compound. Scar tissue gets tight and all of that fascia and connective tissue is woven into the muscles. The way that I was able to resolve all my pain, was to equalize the pressure on both sides of my leg. I used the techniques of myofascial release to stretch out the overly tight areas and surgical scar tissue. It had been bad enough that my ankle would collapse under me, and that seemed to be caused by the scars on my shin where an external cage had been attached right after the injury. After I released those tight adhesions, my ankle was more stable and no longer collapsed when I took a step.

Here is our discussion on Myofascial Release where you can learn more.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
There is a provider search at http://mfrtherapists.com/

Have you heard of Myofascial Release before?