Bruises and weird spots on ankle - Severely sprained almost three years ago...what's up?

by D
(North Dakota)

I'm a 27/f/cashier. I sprained my ankle before I even got my current job. I was stepping out of a car, misjudged the distances to the ground I guess and rolled my right ankle to the inside. I had a VERY large lump on the right side of my right ankle, and bruising right below it under where the normal bump in the shape of your ankle should be. I also grew faint and dizzy and nauseous the pain was so bad. I din't have insurance and I'm usually kind of clumsy, so my mom and I waited a week and no chnage happened so we went to the local health clinic. Of course the bruising and swelling I expected, but almost three years after it seemingly has healed I still have pretty bad pain. I had to wear a boot on the foot for six weeks, but I will be honest I may have skipped the last tail end of the last week because I was afraid my current job wouldn't hire an invalid.

Now the ankle still hurts, it still is bruised, or dark where the first bruises were and there is a weird grouping of spots that start at right above the bump on my ankle (which is still a bit swollen)and roll down to along where it was all puffy and bruised and then trail down my foot in a line to right near the beginning of my second toe.

I'm worried that I have had pain for so long and that the foot still looks so strange. also the veins on the top of my foot sometimes pop out a little and are clearly visible. The top of my foot as well as the side that was a big huge swollen ball when I first hurt it always hurts and sometimes my foot doesn't allow me to walk on it all the way. I had a doctor tell me the spots were just freckles...but I've never had freckles and I don't agree because my foot still hurts so much and I still don't have what I consider to be my full range of motion. The doctors couldn't tell if I had also fractured the ankle. If I had, it would have been a hairline one as far as they could tell. (had an x-ray done).

RESPONSE

Hi D,

At the time of your trauma you suffered what I presume to be an inversion sprain of the ankle, as you say your foot rolled inwards and now all your "issues" are on the outside of the ankle.
In this type of injury the two most common causes of severe and prolonged pain would be an ankle fracture and/or severe damage to the lateral ankle ligaments which are the structures that attach the outside of the leg bone (fibula) to the foot.
The third possibility would be a tear of the peroneus longus tendon which is the muscle that comes down the outside of your leg, goes under the outside ankle bone and then continues along the side of the foot.
So here it is three years later and you still have pain. Since you had a recent x-ray and there is no visible evidence of any fracture, probably in the worst case scenario you may have had a hairline fracture which has healed, so that would not be the cause of your pain.
That leaves us with either a ligament issue or tendon possibility. In most cases it would end up being a ligament issue. If the ligaments were not properly immobilized (the boot) then there would have been excessive scarring which may be the source of your ongoing pain.
It should also be pointed out that perhaps you had a complete tear of the ligaments at the time of your injury and in that case, surgical repair might have been a better option.
The only way you are going to really know what is going on here is for you to have an MRI which is very good at identifying soft tissue damage. Once a proper diagnosis is made it becomes easier to resolve the problem.
As far as the discoloration in the skin, the only thing I can think of without the luxury of actually examining you is what is known as hemosiderin deposits which is basically dry blood spots that have formed under the skin. When you suffered your initial trauma, you evidently broke some blood vessels and some the residual bleeding may have formed these spots.

Marc Mitnick DPM
DISCLAIMER