Restricted Movement from 5 Year Old Ankle Injury

Electric Gypsy

This happened almost 5 years ago when I jumped from too high a height. I landed on a downward slope (downwards in the direction I was facing) with my right foot, but I landed in such a way that my body fell forward too suddenly for my heel to come up with it. I now can't lower that knee as much while keeping my foot flat on the ground. If I do a knee-to-wall stretch with my left foot, the distance from my big toe to the wall is 10.8 cm when my knee just meets the wall, but with my left foot it's 11.6 cm. The ankle is fine in so far as being able to run and do all the exercises I want. But I would like it to be perfect again. I do find though that when playing soccer that if I needed to stop very suddenly, or turn on my side hand side, that I slowed slightly by this.

The physiotherapist who I dealt with first said I'd a sprained right side ATFL ligament and gave exercises to deal with that, which were: double leg calf raise, straight leg calf raise, banded inversion/eversion, knee-to-wall stretch, & single leg stance. The second physio I dealt did strength tests and concluded that both ankles were equally as strong in every way. He said the restricted movement was due to stiff talus bone! There was no mention of the talus bone from the first physio! The advice of this second physio was that I should challenge it by putting it into less extreme versions of what I did when I injured it... like forcing that knee just beyond my comfort when doing the knee-to-wall stretch. If I had the time and discipline I'd like to spend 30 minutes at these stretches every day for two weeks, just to be able to prove that they don't make a difference, but I haven't... I'm almost certain they wouldn't. 

I've noticed that any mention of the word X-ray seem to be brushed aside. I'm told that nothing would show up in an X-ray. But I would like to know what they'd do if it was Lionel Messi's foot that had this problem. What if it were important enough to me, and I were willing to pay for it, what would it take to get an operation?

The thing I don't like is that, if it is the case that this ankle can't be made as good as new, then why do I feel I'd have a hard time finding a physio who'd be willing to tell this straight out. I wouldn't want to end up having to go away and do a whole course of exercises again, just to be told the reason it's not working is because I'm doing them wrong.

I haven't discussed it - with what I'd call - my main physio therapist yet, as I was out of the country when it happened. I'm wondering should I go back to him, or should I try find someone who's a reputation for dealing with ankles.

Thank You

Mellor

The ATFL supports the ankle against plantar flexion, so I wouldn’t expect to injury it with the knee coming over the toes - that would be the posterior ligament. But you could have done it by going laterally over the ankle. Worth bearing in mind when trying to repeat a milder version of the movement.

The T in ATFL stands for Talar - so first PT did refer to your Talus bone. But not not sure if a stiff Talus bone means anything. All bones are stiff. The joint could be stiff for a number of reasons, including the ATFL.

Ligaments and soft tissue injuries won’t show up on an X-ray. You’d need an MRI. If you wanted to go the surgery route you could do so privately. Sounds unnecessary to me though. A surgeon might not support surgery given the difference between the two sides is .8cm, that’s nothing. I’d expect people with healthy ankles to vary that much.

Im not sure what you’ve invented a scenario that the ankle can’t be improved and you’re having a hard time finding a physio who’ll say thing. You’re assuming the stretches won’t work, so haven’t bother to do them. That’s pretty lazy. If you really wanted to improve the ankle you’d do them.

FWIW surgery isn’t a magic cure. Post surgery you, you’ll have inflammation issues, worse mobility. And would likely have to do considerably more rehab that you need to do now.

Electric Gypsy

https://www.boards.ie/discussion/comment/120509895#Comment_120509895

Thanks,

But isn't it a pity that PTs can't do MRIs before they give an exercise plan? 0.8 cm mightn't seem like a lot, but when I get down on the ground to pick something up I really notice it. I'd be willing to do all that after surgery if I was 100% sure I'd get back to normal.

You seem like you know quite a bit about this sort of thing. Do you think it can be improved without surgery?

Black Sheep

https://www.boards.ie/discussion/comment/120529820#Comment_120529820

Routine use of imaging scans like MRI, x-ray and CT aren't currently recommended.

There's obviously a cost implication that someone has to bear, but also it could increase pressure on what resources are there currently- The equipment, the people doing the imaging, the consultant radiologist writing the report etc. The idea is that they should be working on cases where it's clearly merited rather than lots of referrals relating to things like low back pain (Which is what would almost certainly be the majority of referrals, if obtaining an MRI were any easier).

But even if someone isn't bothered about the above, they should bear in mind that there is evidence routine use doesn't benefit the patient most of the time.

There's research that has shown access to MRIs is strongly correlated with patients having a significantly increased chance of surgery afterwards (Baras Sreirbati and Baker, 2011). If you know what an MRI of the average back or shoulder looks like it's no surprise! Most people are better off not knowing.

There are also studies that have shown that in the long term patients who get MRIs early on have no advantage over those who didn't (Karel, 2015).

It's quite common for people to believe an MRI is really important to correctly resolving or identifying their issue. I would have fallen into that category myself in the past.

Over time I've come around to accepting what all the research points towards ... Conservative treatment as being the first thing to exhaust before considering anything else.

If you don't want to bother with it and would rather opt for the surgical route, I don't think you're alone, although it blows my mind that people think this way to go when there's a fair bit of evidence is that surgical outcomes for a lot of musculoskeletal ailments actually aren't that good.

Cill94

https://www.boards.ie/discussion/comment/120531167#Comment_120531167

it blows my mind that people think this way to go when there's a fair bit of evidence is that surgical outcomes for a lot of musculoskeletal ailments actually aren't that good.

It's crazy when you realise how many people are told to go for surgeries that have no evidence to be better than physio. I would not be going under the knife lightly.

Black Sheep

The other thing is it's not like surgery is a window you can miss. You can always try to manage symptoms conservatively before surgery, maybe there's a contrary scenario but it's eluding me if so.

Mellor

https://www.boards.ie/discussion/comment/120529820#Comment_120529820

I’ve spent some time studying flexibility, and ways to improve it. I know a little bit about the structure of the ankle and knee - how ligaments get damaged. I’ve had knee surgery myself.

And I would say with confidence surgery should be a last resort. You’ll come out of surgery with very little ability to move or use the ankle. Could be months of rehab.

You could probably add 1cm to you ankle range in a few weeks if it’s a normal flexibility issue. Which is the limiting factor for most people trying to touch their toes, do the splits etc.

The only way it might not improve would be if you were trying to stretch and bend bone.