My Ankle Injury in October of 2003 – A no-fracture medial-lateral ankle sprain with a deep-deltoid tear
I had a fracture-less lateral-medial ankle sprain in October of 2003. Sprained it when side-stepping instead of down-stepping a 6″ sidewalk curb. It rolled laterally. The knee buckled and there was a lot of calf torque (I have huge calves) while the ankle was rolling. I did not fall. Normally my weight would shift to the other leg when the knee buckles, but it was up on the curb. I know my leg muscles (especially quads/calves) are perfectly capable of supporting a slightly flexed knee, which is probably why I didn’t fall. The ankle popped (probably the ATFL tearing out fully) after the knee buckled. I think the proces of injury ceased when my other leg finally (probably a second late) got off from the top of the curb to get the weight off my cocked right ankle.
I think the injury mechanic was inversion + extreme plantar-flexion + some rotation of the foot inward (This pattern is what made the ankle hurt most after the sprain – Hard plantar-flex, roll-out (invert) , rotate foot inward). I bore weight on the bumpy thing on the outside of the ankle (lateral malleous) and my inside (medial) of the knee hurt a little (sensitive but didn’t affect walking) for about a day, so I probably subluxed the hell out of my tibia/fibula (enough to minorly affect the knee) from the weight-bearing on the outside bumpy thing / malleous. The ankle, up until 1-2 hours, was relatively pain-free, as long as lower-leg muscle tension was maintained. I was walking limp-free but slowly. After the swelling started though, it was very painful.
There was bruising on both sides of the ankle at the 3rd-5th day post-injury. After 2 days I was weight-bearing pain-free. After about 5-days, I stopped using the crutches for walking (I never really used two except to help in turning) as they weren’t helping me walk faster (they were slowing me down), but I would still carry one for another week or two to help with step-downs. After 2 weeks, I dumped the crutches altogether. I had to be careful to not have any sideways momentum (left or right) when placing weight on the ankle for about 4 weeks. Another problem at 2-6 weeks is that I couldn’t pronate the foot and had keep the weight on the outside and maintain some minor muscle tension to keep it from hurting (not too bad though). The doctor was surprised at my range of motion 1 1/2 to 2 weeks after the injury but sent me to get an MRI because it was still really swollen on both sides. The MRI revealed the deep deltoid tibio-talar tear. I read the deltoid ligament tears are very rare without a fracture (ankle or leg) and often avulse the bone instead (tear the piece of bone at the attatchment point off). The ankle hurt with any use of the calf muscle at all for about a week. Then I could minorly use it for the 2nd week. After 3-4 weeks I could use my caff pain-free enough to use it to stabilse the ankle on rough ground. It took 2 1/2 weeks for me to be able to ascend stairs at a normal pace. After about 4-6 weeks I was able to descend stairs without trouble but still couldn’t run or jog because of medial pain.
I finally saw a specialist 6-weeks after my injury because there was still swelling and I couldn’t run or put a lot of right-leg torque pedaling a bicycle. He gave me a shot and had me come 2-weeks later. I don’t think the shot helped at all. It made it take more to get it to hurt, but when it did hurt, it hurt more. The doctor said I would normally need surgery, but I have much to loose in terms of strength and range-of-motion and many doctors, including him, have 0-experience at medial-ankle surgery and the remainder have very-limited experience, So I agreed to no-surgery.
I got a ankle constraint after seeing the specialist but I didn’t use it as it didn’t work and was also uncomfortable because it didn’t fit around my bulging calf. I also got a 8-week rehab prescription but I was only able to go 3 weeks because of insurance limitations. STI Physical Therapy and Rehabilitation is a really good rehab place. Great service. Only catch is that they are not subjugated by HMO and PPO networks, so it was ‘classic’ or out-of-network only PPO. The Ultrasound was probably the most helpful part of the rehab specific to my injury. Most of the non-routine therapy was proprioception and balance as my strength and Range of Motion (ROM) was more than adequate (The star-exercise was the most difficult for me). Rehab on aggregate got me able to jog on the ankle, but I, even as of this day can’t run normally. I also have a bit of lateral-ankle instability but it is only an issue if the muscle stabilization is neutralized somehow (un-awareness of terrain or akward position). If I’m aware of the terrain, I can go over rough rocky-terrain without turning the ankle but it often feels like it wants to go unless there is calf or outside-lower leg tension (enough to feel stiffness/contraction but not heavy straining).
Now I can run a few hundred feet at a time strength-shoe style, on my toes. Any pronation while running is met with pain on the inside-front of the ankle after the 2nd-4th impact. But I hardly run in my routine life and my ankle handles hill-climbing torque on my bicycle without pain as long as the weight is not on the inside of my arch, and I walked normally from the 2nd day after my injury and handled stairs normally after 4-6 weeks (1 1/2 – 2 weeks for up, 4-6 weeks for down), so I wouldn’t go get surgery unless I really really wanted to play soccer again or anything else that needs a lot of running. I also cannot trap high-speed balls (20mph+) on the mid-arch to heel as it aggravates the medial ankle (had it happen once) and renders it sensitive for about a week two. Dribbling and passing are no issue. Can take shots too. I can turn and cut on the ankle wihtout pain or failure but there are intermittent proprioceptive / coordination failures if there is insufficient calf support and I let the weight fall on the heel to much. The media ankle sometimes cracks when I turn on the right knee in a casual scenario (weight a little back, some calf tension to lock the foot, turn on the right knoee knee). It doesn’t hurt and there is no feeling of slippage but sometimes it can be fairly audible. In a active scenario my weight is sually more forward with more active msucle support and it hardly ever cracks.
I think the reason that I had no fracture is because of my genetics. My father has never broken a bone in his life, though he has had a number of ‘bone bruises’ (‘occult fracture’ or ‘occult contusion’???) from motorcycle accidents. My father probably has flexible bones. My mother has heavy bones. I seem to have both heavy AND flexible bones (I overheard a doctor commenting on the size of my tibia and achilles tendon from when I sprained my left knee). I think a normal person would’ve broken their leg before tearing their medial ligaments as I had half or more of my weight on my lateral malleous (the ball/bump on the outside of the angle).
| Here’s really good Anatomy map of the ankle that makes Gray’s Anatomy look like an obsolete joke (at least for the medial ankle). Applicable figures for my Injury are 8, 9 and 10 with the injury being on Figure 8 : Pin 9 (ATFL Anterior Talo-Fibular Ligament Complete Tear), Figure 8 : Pin 11 (CFL Calcaneo-Fibular ligament Partial Tear, not mentioned in MRI), and Figure 10 : Pin 2 (Anterior TibioTalar Ligament on the Deep fibers of the Deltoid Ligament Badly Torn).Anatomy of the talus and the surrounding bony and articular structures – JOINTS INVOLVING THE TALUS |  |
Here is my X-Ray and MRI reports regarding this injury. Impressions #1-3 are definitely from this injury. #4 probably is as it doesn’t hurt there anymore. #5 is not and I still have it. I license these reports/scans under Creative Commons Attribution Share-Alike License. Feel free to use it in your medical research and case studies, just give credit and let the other people copy and share it.
Click on the image below to get the full-size scan.
