Severe pain in ankle and foot, 11 weeks after sprain

by Sarah
(Denver, CO)

I was diagnosed with a severe sprain 11 weeks ago, fell on some steps and heard and felt a loud crack on the outer part of my foot. Was diagnosed with an avulsion fracture at the ER but Ortho said no fracture was present, he did say there was a bone chip but that could have been there before.

Couldn't move my foot at all for 3 weeks, the pain was off the charts. Put in a walking boot at 3 weeks and told to start walking.
Have been in PT for 3 weeks now but she sent me back to Ortho as the pain is still bad, also cannot move my left foot sideways.

Ortho seems unconcerned, the pain has me awake at night, I do wear an ankle brace which makes my ankle feel more secure.

The pain is on the outer side of my foot, outer side of ankle, pain on the top of my foot but also underneath, on top the pain shoots up in to my toes when I touch it. When I walk I can feel pain on the outer side of foot with every step.

does all this sounds normal? I'm worried. Thank you.

RESPONSE

Hi Sarah,

In most ankle sprains, by eleven weeks, the incident should be a distant memory. In simple sprains, all things being equal, two to three weeks is usually all it takes in an otherwise healthy individual.

Well, you are way beyond three weeks and according to you, still in a lot of pain.

An avulsion fracture is a fracture of bone as a result of a stretching of a ligament and essentially pulling a piece of bone off the main bone. In an ankle sprain the lateral ankle ligaments are the ones that are stretched and they can avulse part of the bone. I would like to know if the "bone chip" that was noted by the orthopedist is in the area of the lateral ankle ligaments and thus would be an avulsion fracture. It certainly might explain why eleven weeks down the road you are still in a lot of pain.

Possibly a bigger issue is your foot itself. You state that you felt a large crack on the outside of your foot. In all inversion sprains where the ankle rolls inward, the outside of the foot has to be examined.

The fifth metatarsal base which is represented by the flare on the outside of the foot is very susceptible to fracture in an inversion sprain. To make matters worse if there is a fracture at the base, it can be very slow to heal and many times may not heal simply because the blood supply to this part of the bone is very poor.

Has this portion of your foot been examined and have you had physical therapy on the foot? If not, that is probably where attention should be directed, if for no other reason, that is where you heard the crack.

You can question the orthopedist about the foot specifically but it does not sound like he is very engaged in your problem. If you were my patient, I would be concerned after eleven weeks with the amount of pain you are still experiencing.

If an x-ray was initially taken of the foot and it was negative at the time, I would certainly recommend a new set of x-rays and if they show nothing than an MRI would be in order.

I do not have a crystal ball, but if you are still having so much pain, I would be surprised if there was not a fracture of the fifth metatarsal or to a lesser extent the cuboid bone which is the bone behind the fifth metatarsal bone.

Talk to your doctor,if you do not get the satisfaction you expect, go see another doctor.

Marc Mitnick DPM
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