Newsletter

Sports

Body

Conditions & Symptoms

Treatments

RSS feed

Syndicate content

Ankle Strain problems 7 months on

Question: Ankle Strain problems 7 months on

Hi! I'm new to the forums.

The situation:
Almost nine months ago, I strained my ankle in an over-use injury for work (a tendon behind my lateral malleolus; I know bones but not tendons and ligaments, so it's around that area - behind my outer ankle, for non-bone people). I originally had a poor diagnosis and didn't address it as well as I should've. When the injury (predictably) recurred about 6 weeks later, I began regular physical therapy and doctors' visits. I have been consistently doing this for the last 7 months. Many of my exercises are described on this site in some place or another. About three months ago, my doctor encouraged me to start exercising at the gym; shortly after, to start hiking again.

I did fine at the gym, and at some basic hikes, but as soon as I tried progressing to what I'd consider a moderate hike (easily within my reach pre-injury) is now incredibly strenuous, I can't finish, and causes bad relapses in how my ankle is progressing.

I will admit that this disheartened me and I have since not been as good about doing my PT exercises daily. I know to some extent, my ankle may never operate at full capacity, but my question is this:

**For how long I've been doing physical therapy (which had become very easy) and for how well I'd been doing in the gym, should I have expected such difficulty hiking a moderate hike?

**Has anyone else had problems like this with recovery, and if so, how have you dealt with them? I need to be able to hike long distances in difficult terrain for work, so the longer my recovery takes, the longer I am out of work. I am worried that taking anti-inflammatory meds and using a brace at work aren't enough to keep me from a serious relapse and putting me back at square one.

Thanks for any ideas or help; I could really use some ideas from other people who've dealt with this before.

Answer:

Ankle sprains are notorious for becoming chronic if not rehabilitated correctly. I assume when you mention a tendon on the outside of your ankle that this is one of the Peroneal tendons. Do you happen to know what the final diagnosis was? Inversion sprains can often damage not only the ligaments supporting the outside of the ankle but also overstrain and/or cause subluxtion of the peroneal tendons.
I would assume a lot of your rehab would have focussed on strengthening & working on the endurance of the Peroneal muscles? As well as a lot of wobble board work to improve proprioception? Have you reviewed your footwear? i.e. what may have been ok pre-injury may not necessarily be suitable post-injury. Also, it's important to gradually increase intensity (this also applies to your rehab. If rehab becomes easy then maybe this needs to increase in intensity also so as to improve the muscle/tendon's ability to cope). Maybe strapping might be a better to approach than wearing a brace in this case as it can provide better support than braces. Also greater shoe support may help to stabilise the foot better. In this case it may be worth visiting a podiatrist to provide greater supporting insoles.
Hope some of this may help.

Answer:

Thanks Farrelly-

Yes, it's one of my Peroneal tendons; I also remember my PT saying I damaged my soleal/soleus. I will ask the next time I'm in whether or not it's an inversion sprain. No one has ever used that term before, but I think it is, based on where my pain is.

My rehab has been scaled back and forth depending on how well I'm doing. Right now, it just got scaled back to 4 daily stretches with my knee straight/bent and two sets of going up and down on my tip-toes (injured foot only) on a stair with my leg straight/bent. Three days of the week I also do side-to-side jogging with my feet crossing over one another, balancing on a pillow with my eyes closed, balancing while I kick my non-injured leg from side to side, several kinds of stretches using elastic bands, and several calf & hip strengthening exercises. I used to do all of this and three or four more things daily. This list isn't exhaustive, and I know there's a lot of exercises that will achieve the same goal.

I have changed my footwear & seen a podiatrist, so right now I've got more supportive footwear and specialty shoes. I will look into strapping.

I got a job offer to do fieldwork in June. This would be walking for 6-10 hours a day 4 days a week in the mountains (we follow the contour, so while there will always be some up-and-down, it's not the same as hiking a mountaintop 4 days a week). I've had some minor pain - less than a 4 on a scale to 10 - when I've gone on moderate 4-6 mile hikes. Is it unreasonable (or downright stupid) to assume in ~2 months I'd be capable enough for the job? If possible, how much time each day should I be doing endurance training in addition to my exercises if I'm on a 2-month time frame? I am talking with my PT about this, and know it depends. I've always been able to keep in shape through extracurriculars, so I don't know what's reasonable to expect in 2 months of actual training.

Thanks again for all your help! I know these injuries are famous for becoming chronic, I just don't know what limitations are common from here on out.

Answer:

It's really hard to tell to be honest. It sounds like you are doing all you can to get things right. If there is chronic instability of the ankle due to ligament laxity you could discuss with your PT and Doc the possibility of prolotherapy which is a treatment that involves several injections into the injured ligaments to help shorten & strengthen the ligaments. It may be worth considering if you are not getting any better with your continued rehab. I would however, definitely try strapping the ankle and see how you get on.