Ankle pain.

[PedroH]

Hi Dr.Gross.I'll try to shorten a long story. Nov.,2008 I slipped on ice and broke tib/fib w/ quite commuted malleoli (? is that the plural?ha) Anyway, I was hospitalized and had IM nail (tibial) and screws placed 48 hours later.Was hospiltalized for another 3 days after that.Other than severe swelling alot of pain& no dorsiflexion thought I was healing relatively well-5 months after, my fibular fracture still hadn't healed  so had a bone graft. (all the while going to PT 2-3 times a week.) Fibula fracture healed but was still having quite alot of pain,swelling,no dorsiflexion,painful numbness on the top of foot.CT done and was thought I had AVN of talus-went to another specialist who said this wasn't the case w/out even looking at the CT.Back to my regular OS who thought I should have hardware removed.So,August 2010 had all hardware removed and I have had little to no improvement.Last Xrays I had flattening of talus and narrowing of the joint.Another CT was ordered along w/another referal to yet another OS-this was done almost 4 months ago and I'm still waiting-(Canada is a lovely place for healthcare!Ha) My question is,what could my problem be and by waiting this long is it making it worse? My whole leg is wasting away and I'm about as frustrated as one can get.   Thanks so much for your time!

[Michael L Gross, MD]

Casting is less likely to be successful for an older injury but it can be successful, particularly if the lesion is not displaced, and there is no fluid underneath.  If surgical treatment is nescessary, it may be either removal of the fragment, with revacularization of the bed, or repair of the fragment.  See an orthopedic foot and ankle specialist you are confident in, and have him evaluate you, and the MRI.

[PedroH]

I don't have an appointment w/a surgeon until April-is there anything I should or shouldn't be doing until then?My ankle seems to be locking up and popping (painfully I might add) on a regular basis right on top where the tibia&talus meet.Is this normal for my type of injury? Thanks once again!

[PedroH]

One more question-would it be too late to just cast my leg and be NWB for a spell or is this treatment only for new injuries?   Thanks again!

[PedroH]

Hi there!  I have finally received my radiology report and have a few questions.-The impression from the radiologist is osteochondritis dissecans medial dome of talus-which measures 1cm AP,0.7cm CC and 0.7cm transverse.-.Secondary osteoarthritic changes to ankle joint. What is the treatment for this,why had they confused this with AVN & how serious is this? Thanks again for your time& knowledge!

[Michael L Gross, MD]

You may have had an unrecognized fracture of the neck of the talus and subsequently develpoed AVN.  Find an orthopedist who specializes in foot and ankle and get his opinion