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Submitted by: Bart - SII

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Continued pain 8 weeks after an ankle sprain is not uncommon. However, she should be seeing some improvement. How did she hurt her ankle? Did they take X-rays after the injury to make sure that there was not a fracture? Has she had any other diagnostic tests, such as an MRI or CT scan? If she was my patient, I would be concerned after 8 weeks if she was still having pain - much like her PT is...however, instead of not wanting to treat her, I would recommend further diagnostics with the physician. She may be suffering from an ankle sprain, but there could be damage to the articular cartilage within the ankle joint - this would only show up with an MRI or CT scan. Are there any specific activities that seem to cause increased pain or that cause the ankle to swell up? These can sometimes be an indicator of other problems besides a simple sprain. As long as she is making some improvements weekly, I would continue with the therapy and give it time...but if she hasn't seen much progress over the last few weeks, then I would recheck with the doctor and make sure that there aren't other diganostics that can be done to make sure there isn't some other type of damage than what was originally thought. Hope this helps - comment back if you have other questions.

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Submitted by: Paul

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She went to turn suddenly and her ankle folded over (taking a left turn, left ankle folded, so the outer side got stretched). She did indeed have a facture and had to wear an air cast for a while until that healed. No MRI has been performed at this time. Her last visit to the doctor is why I am asking questions here. He would not take the time to listen to her and drew his own conclusions based on what he wanted to hear, frustrating! He asked if there had been any improvement, and she said "yes, it is 65% better". What she meant was 65% better since it happened, not in the past 3 weeks, but he wrote it up as if it got 65% better in the past few weeks. When she questioned the nurse and tried to explain, the nurse would not listen! The doctor was too busy to talk to her... Anyhow, the therapist is 100% right in that she wants to treat the ankle, but she wants the foot doctor to peform more tests to see if there is something they have missed. I guess we need to find another doctor who isn't too busy to listen and follow through. The main problem at this point is that it swells really bad (and is painful) when she is on it for any length of time, but some days it is better than others. So your recommendation is to find a doctor who will perform an MRI? I guess my question is, after 8 weeks should it still swell (a lot) and be painful after being walked on for an hour? Or is that an indication that something more serious has happened? Thank you very much for your time! -Paul P.S. How can we find the best foot doctor in the Fitchburg/boston area?

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Submitted by: Bart - SII

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I hate it when physicians book themselves so busy that they can't take the time to actually listen to their patients concerns! I do think that a lot of swelling in the ankle after just an hour or so of walking and significant increases in pain are an indicator that there could be something else going on. It sounds like the therapist is exactly right in that they want to continue to treat her ankle, but are concerned about other problems other than just the sprain and healed fracture. I would highly recommend further diagnostics. I would talk to the therapist and see if they have a relationship with the physician in that they can persuade further diagnostics. I know that I have this type of relationship with my doctors, and I can often make a call and get tests ordered by the physician based on my clinical findings - not all therapists have this relationship though. Your PT would also be a good person to talk to about a doctor for a second opinion. Every clinician has their favorite doctors for different types of injuries - ones they use regularly and who the see lots of patients from. Another place to get a referral is from your primary care / family doctor (if that isn't the one already treating the ankle sprain/fracture). You may also try looking online at your local hospitals website - they often list their physicians and their specailties out on their biography or department pages. I hope this helps - keep us posted on how your wife progresses - Good luck! Bart

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Submitted by: Anonymous

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Swelling and pain can last up to 12 to 18 MONTHS after something like this. Some people do not realize this. It is very painful and frustrating when people tell you to hurry up and wait. But it is true. It will take time, patience, and she should be icing and elevating that ankle still as well. Also if she starts having tremors or really bad charlie horse -- leg cramps make sure you use moist heat. Icing and heating should always only be done for 10 - 15 minutes at a time.

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Submitted by: Bart - SII

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But an ankle sprain, even with an associated fracture (that we assume has healed since she is no longer in the cast) should not have severe swelling (as compared to the initial injury) with walking and ADL's. This is a red flag that there could be some other type of injury - articular in nature, and warrants further diagnostics, if for no other reason than to rule out possible intra-articular injury. Ankle swelling can continue for months after a sprain, but it should be minimal, not like the initial injury. I would respectfully disagree with the recommendation for heat on an area that is suffering from swelling. Ice and elevation yes, but not heat. If swelling wasn't an issue, I would feel differently. Bart

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