Severe Ankle Sprain (Pics) - Input/Opinion?

EDIT ON PHOTOS, view them here: http://www.freshed.com/sample_dev/ankle_ja n19_2012/

JoshL,

You have done well in managing the acute edema and the injury in general.

Being an athlete, you know that sprains can be mild, moderate, or severe. There is some correlation between the amount of swelling and the amount of damage, but not always. Since you have managed the injury well, the outward appearance may be deceiving.

The blue bruising is doing what it does best, travel in the direction of gravity. It is not uncommon to see blue toes, feet, ankles, and even up the leg after an ankle sprain. If a patient elevates the foot way above the heart, it is not uncommon to see the bruising going up the back of the calf. When the foot is held in a dependent position (hanging down), the bruising goes into the foot and toes.


When you first described your injury, I thought that you may have had a midfoot sprain (across the instep) when you said, "over-rotating my right foot, putting all of my weight on the top of the foot". But, I was a little confused, because most of your swelling is around the ankle. And, not quite sure of what you mean by, "over-extended it from the anterior angle".


Without a thorough examination, it is not really possible to tell what you have torn. But, the lateral ligaments of the ankle, the anterior talofibular (ATF), the calcaneofibular (CF), and the posterior talofibular (PTF) would be the best bet.

It is not uncommon to damage all three in a significant injury. The PTF ligament helps to keep the talus from sliding posterior relative to the tibia. It is often considered the most stout of the three ligaments. It can be injured with an inversion force and also from stopping abruptly.

When examining the ankle, the orthopedic surgeon will palpate each of the ligaments, to see if they are tender. He/she will also test the integrity of the ligaments by doing stress tests, such as the talar tilt and anterior drawer. X-rays are usually obtained, just to make sure there are no osseous injuries. One injury particular to ankle sprains is an osteochondral defect (OCD) of the talar dome.


But, again, the only way to know for sure what you have injured is to have the ankle examined by an orthopedic surgeon.


In your rehab of the ankle, which you are doing well with so far, be sure to stress strengthening of the peroneal muscles on the lateral side of the leg. And, one thing that patients forget to work on, before getting back into activity, is proprioception. Significant injuries can really mess up the delicate unconscious motor control of the extremities. So, if you have access to a physical therapy department or a training room, you might want to work on the balance board for ankle rehab.


Good luck on your recovery and rehabilitation.

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JoshL,

Wow, your pictures resemble the swelling and bruising in my foot from my sprain a year ago so much. I was running down the stairs and was skipping steps and when I landed on my right foot, the ankle rolled outwards and I heard a pop. And that swelling started almost immediately. And I remember the bruising was terrible. I was curious...did you hear a pop when it happened? And how is your ankle as far as instability now that it is a year later? Immediately afterwards, and still to this day, I feel like my ankle is very unstable, when I sit with my leg straight out and toes pointed up. And also when I turn to quickly with my foot still planted. I'm waiting to schedule and MRI for next week after seeing the doctor yesterday, but I was just curious about the popping noise and if you have any instability issues over the past year. Thanks! And hope your recovery went smoothly.