"I sprained my ankle"

He was 42, a former competitive college athlete. He had "let himself go" and wanted to get back into shape. He started with doing some light activities and running. After running just, a couple of weeks he noticed his ankle began to bother him. One morning upon arising, the pain was significantly worse. "I must have sprained it" was his thought and so he presented to my office with that complaint.

He pointed to the left side of his right ankle. It was tender to touch, warm and did show evidence of edema or swelling. He had difficulty with propelling himself, lifting up on his tiptoes and going up and even down steps without pain. Some days it felt better, while others it felt worse, even weak. Certain shoes seemed to make it feel more comfortable as well. X-rays were negative. His ankle was stable and showed no problems to the ligaments.

His problem was inflammation of a major tendon along the inside of the ankle called the tibialis posterior. This tendon is a major supporter of the arch and aids with walking and running.

He initially was treated with a period of rest with both a cast and a walking cast boot, and anti-inflammatories. He felt much better and after physical therapy, I put him in an ankle brace and allowed him to return to activity slowly. But he was back in shortly as the pain was returning. I ordered an MRI and he was found to have fluid around the tendon. There was no evidence of a tear.

Further rest and treatment did not give him resolve so ultimately, he elected for surgery.  In surgery, I found the tendon to have a small tear within it that was removed and repaired during that surgery.  He recovered well with further therapy, rest and ultimately a return to his activities in a graduated pace while wearing appropriate bracing with athletic shoes and graduating from that brace into custom-made shoe inserts called orthotics.

If he had presented to the office sooner, it is likely that I could have treated this in a conservative manner and resolved his problem much quicker, even avoiding surgery. But he thought he could shake it off. One thing I can assure you is that as our bodies age, we can't shake things off like we used to. Our muscle mass is still present but our tendons become thinner and weaker and more subject to injury.

So, if you have an ache or pain or strain, don't try to tough it out or shake it off. Seek medical attention before the problem becomes a surgical one.

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