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Sports Medicine

Right Ankle Injury

01/11/2011

Question:

Last February I slipped on ice and fell down a flight of concrete steps about 4 feet high. I had x-rays and an exam done and the diagnosis was just a bruise; however the injury never fully healed. In December of this year I went to another doctor who ordered an MRI and the findings were marrow edema in the medial and lateral talar dome without discrete chondral defects and small joint effusion, also a deltoid ligament injury.

The treatment has been 4-6 weeks in a CAM boot, however the injury has not really responded like I had hoped. It still swells at the end of the day and is painful if I press along the side of my ankle, is there anything else I can do to speed healing? Is this the best treatment option? Should I see another doctor? Thanks for all your help!

Answer:

(Bone) marrow edema and joint effusion (excess fluid in the joint) indicate joint damage or irritation. If the majority of your symptoms were due to joint looseness/instability, the walking (CAM) boot should have helped significantly. However, if most of your symptoms are due to inflammation of weight-bearing joint surfaces (for example, "arthritis" or "synovitis"), wearing a boot doesn't reduce the compressive load of your body weight onto these joint surfaces. 

You might ask your physician whether or not a period of reduced/partial weight-bearing (as can result from using a cane or crutch in the opposite hand) would be appropriate to allow this to calm down, possibly while also continuing to wear the boot.

Your physician should also be able to determine whether or not your ankle joint is "loose" as a result of the deltoid (medial) ligament injury and if so, whether surgery should be performed.

Additional treatment options to discuss, if appropriate to your situation, include:


- anti-inflammatory medications (oral and/or topical), 


- compressive wrapping, 


- trial use of a foot orthosis (shoe insert), 


- optimal footwear/shoes, 


- weight loss, 


- aerobic reconditioning, 


- physical therapy for pain-relieving physical modalities in conjunction with a progressive strengthening/stretching/range of motion exercise program, and/or 


- steroid injection into either the ankle joint or possibly into the subtalar joint, which is just beneath the talus (ankle bone).

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University