Pain, Swelling and bruising in ankle w/bottom & behind heel pain.Over 2 inch Indent at side of calf. Pain when moving or curling my toes. Some pain behind knee and down leg.

by Sharon
(Carmi, IL, US)

I am a 41 year old female. I had been walking on my heels for a couple of weeks bc both toes were infected from a procedure I had to get done. I kept them out of the water when I got in out of bathtub when they got infected the second time. I wonder if I injured myself doing this. There were times I had pain the way I had to walk and stretch. One time it was pretty painful but than just went away within a few minutes.

I was sitting down and my ankle swelled huge before our eyes. At first it just looked like a huge amount of fluid and it was skin color and was not warm. It didn't hurt at all, I could walk and move my foot in all directions. I was misdiagnosed with gout. A few hours later it turned dark red. It swelled back up every time I walked on it and changed colors from red, purple, green back to purple. One week later the side of my calf sunk in with long socks. The indent was about 3 inches deep and 4 inches wide. That's when it started to hurt to walk on it. By morning it was about a 1/2 inch deep and 2 inches wide. The indent is still there, sitting or standing. A blood clot ultra sound was done, eco cardiogram of heart, blood test, x rays, all of which were fine.
I was than sent to an ortho Dr. who did an MRI just of the ankle. I wish he would have done an MRI of the calf too. The MRI showed no injury but extra fluid and thickening. The radiologist said it was not an ortho problem and suggested I see a Rhematologist. I'm waiting on that appointment. I'm wondering if it could be a prenous longus injury. I do have a swollen lymph node on the side of my right neck now, not sure if that's from my allergies or everything else that's going on.
I have had trouble for about 3 years with my arms. I had a compressed ulnar nerve in left arm and have never regained the feeling completely in those fingers. I have sharp pains in both forearms much worse than my ankle or leg has ever felt. I have been diagnosed with a degenerative disease in 2 cervical disk in my neck that could attribute to all my arm trouble. My arms wake me up with pain and numbness a few times a month.
I have thyroid and take synthroid. I also have been diagnosed with narcolepsy and take provigil a few times a week. I have asthma.
Hopefully you can let me know if I need to pursue a ortho Dr. again or if I should just stick with the Rhematologist. I will attach photos.

RESPONSE

Hi Sharon,

So if I understand this correctly, you have infected toenails from a procedure and because in an effort to protect them you have been walking on your heels, then your right ankle all of a sudden blows up on you.
The more serious potential problems such as a DVT, or blood clot is ruled out so we can assume this swelling is a local manifestation with the assumption that your heel walking has somehow caused this.
The MRI of the ankle was a good idea but more than likely the peroneal tendons as they come down the past the ankle joint were probably visualized and if that is the case, then the radiologist would have commented on any abnormality of those tendons. If there is still an indent further up in your calf that should probably be investigated, more than likely with an MRI.
I do not see how a rheumatologist would be of much help with this and I think the orthopedist is the one to see. You might ask he or she to revisit your MRI and look specifically at the peroneal tendons just to make sure.
One would think that there is some kind of "cause and effect" between your heel walking and the onset of this swelling.
One area of concern for me without having the luxury of actually examining you is the distinct swelling on the outside of the ankle. I am looking at a small picture, but the one where the ankle is very red and swollen might lead someone to the conclusion that you have a growth on the outside of the ankle. Have your doctors determined that there is no growth and this swelling is from inflammation? Generally speaking when people have swelling from inflammation, the whole foot will be swollen and not limited to this specific area.
I wish I could be more help, but your pictures just give a minimal amount of information, but again I think the orthopedist is the one to follow up with.

Marc Mitnick DPM
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