I’m hoping someone on here might have the knowledge (and patience) to help me translate MRI findings to everyday speak and maybe someone has experience with this type of injury and its management...
Here is what happened:
early July – impact injury to right ankle
This was from a downward fall of about 3-4 feet, all my weight ended up on the outside of my right ankle and it kind of bent outwards and started swelling immediately; however, it didn’t hurt much and I was able to walk almost normally the following day; there was a lot of purple bruising which went away within days, but the swelling persisted.
I was concerned that the impact force might have done some internal damage to my ankle or that there might be hairline or stress fracture. I went to my GP a few days later to get the foot checked out and just in case I needed an xray. The GP decided that nothing was broken as I was able to walk normally, but did give me a referral to see a physio upon my request (note: this is Australia – physiotherapists are the practitioners of choice with most injuries). I saw a physio, he gave me some strengthening exercises to do, and recommended massage and a bit of tight bandaging for the swelling.
July to October – I gradually resumed some of my usual activities, though at a very reduced intensity. Some movements caused a bit of tenderness in the ankle. There was no pain, but the ankle stayed visibly puffy and seemed to give me a bit of a niggle at times. I had this strange feeling of it not being quite there – like if it would take a second or two for the ankle to get ‘activated’ and recognize the rest of my body and do what I was asking it to do.
October – by this point I felt that the ankle had recovered to about 90%. Still puffy, and some movements would cause a bit of a reaction – not pain, not tenderness, but just a reaction of sorts, which I wasn’t having in the other foot.
late October - I wanted to get back into long distance running, and wanted to make sure it would be okay, so I went to see my sports physician (he had helped me with a weird impingement in my other ankle a couple of years ago by means of a cortisone injection).
Sports physician ordered xray just in case, which came out fine, so he gave me a cortisone injection and said I should be good within 2-3 weeks.
Two days later I woke up at night in agony and unable to walk – I could not bear to stand on my foot (it would bear weight, but it would be incredibly achy). The foot felt extremely stiff and sore.
I called the doctor who said a flare up can happen from time to time and to give it a couple of days. And indeed three days later my foot seemed back to normal. Except the following night I once again woke up in immense pain (the worst pain of my life which would not lessen even with a maximum dose of over the counter painkillers). I called the doctor again, who said that the foot wasn’t behaving the way it was supposed to and recommended a MRI if the pain didn’t settle. I had a couple more (though slightly less intense) flare ups, and eventually booked the MRI.
mid-November – MRI
I can copy the full report separately, but here are the conclusions:
“transchondral lesion of the medial talar dome with a focal chondral defect and quite extensive bone oedema extending through the medial half of the talus”
This was 3 weeks after the cortisone injection. And over 4 months following my initial injury and nearly 4 months of using the foot with it being about 90% ok. I had had NO pain and NO difficulty with walking for most of those 4 months, until after the cortisone injection.
My sports physician had a look at the MRI results and said I’d given the ankle a nasty bash and that he was concerned about a bit of bone which seemed to have come detached. Diagnosed bone bruising and advised time, but told me to keep being active if I wanted to.
In the month after the MRI, the flare ups subsided to an extent, but only to an extent. They became shorter in duration but very unpredictable. Sometimes, it would flare up for a 20 minute period - very randomly.
One weekend, I went on an outdoors trip and found myself unable to walk upon arrival (this time, the ankle felt painful and tender when deployed over uneven terrain, there was no stiffness). However, the following morning it felt fine and I was able to do a few hours of (very easy) rock climbing and then walk over rocky terrain with no problem. Similar thing happened a couple of weeks later on a beach weekend – the first day walking over uneven, moving sand was hurting, the following day it was fine.
I saw the sports physician again, who was puzzled, and told me that he could not justify sending me to a surgeon because I was not in pain and able to do whatever I wanted most of the time. He reckoned the ankle needed more time. He could not explain why the flare up happened after the cortisone injection and why it was so severe when I’d been ok for 4 months.
It’s 10 weeks since the cortisone injection, 7 weeks since the MRI and exactly 6 months since the injury.
The flare ups are still happening, but their nature has changed – now it’s just intense stiffness which does not respond to pain killers or to anti-inflammatory medication. Taping the ankle doesn’t do anything. Sometimes the stiffness develops after activity (like gentle hiking), sometimes for no apparent reason at all – and hangs about for about 16 hours, then goes away quite suddenly. I can be limping badly and then walking almost normally 5 minutes later, until the next flare up. Any sort of hopping/jumping up and down causes dull but strong pain.
I’m trying to get another appointment with my sports physician, but he’s booked out for a few weeks.
What I’d like to know:
- what does the MRI mean (i.e. what is actually wrong with my ankle in non medical speak???)
- how can it be that it was 90% fine for 4 months and then became pretty much unusable immediately after the cortisone injection (I could understand a gradual worsening over the last 6 months if there is a damage inside my ankle, but the suddenness and intensity of the pain is puzzling)
- what now? wait more and do nothing in the meantime? investigate surgery options?
- is surgery the only way?
- if I need to have surgery, how long will I be out of activity? how long will it take before I can head out for a cruisy casual 30+ km run? will I ever be able to do that again?
It is pretty clear that the injury is affecting me and getting in the way of what I want to do. It would be fine if I lived a more sedentary lifestyle. But I don’t. I am a very active person (long distance running, trail running, hiking, rock climbing, bike and other activities in the outdoors – has to be outdoors and in nature). The added complication is that I’m a full time student and very pressed financially – and only have basic health insurance which has a restricted level of cover for things such as arthroscopy and surgery (it might cover the investigation, but not any actual repair work). I don’t have the means to pay for surgery.
Not being able to do things is killing me and I’m really struggling on a mental/emotional level. Activity, especially long distance running, is my way to inner peace and a means of working through stress and bad days etc.. I’m dealing with some personal stuff at the moment also, and it’s been quite uphill. I’ve been crying every day and really struggling. I can’t bear the thought of not being able to run and climb for months.
I hope someone here will be able to shed some light. Thank you so much in advance.
Full MRI findings
There is a discrete osteochondral lesion seen over the medial side of the talar dome. There is a focal 2mm area of chondral deficiency associated with a transchondral cleft. There is intense high signal seen through the talus.
In addition, there is a second osteochondral lesion seen over the lateral side of the talar dome. There is a focal area of chondral loss with subcortical cystic change and a moderate amount of bone oedema.
In addition, there is a large ankle joint effusion with a synovitis. The subtalar and talonavicular joints are intact. I note an accessory os navicularis and this distorts the talonavicular joint ligament. The anterior process of the calcaneus is preserved.
The Achilles tendon and plantar fascia are preserved. The ligaments of the distal syndesmosis are intact. The has been high-grade tearing of the anterior talofibular ligament with a disorganized frayed ligament. There is scarring of the extensor retinaculum and there is marked thickening and fraying of the calcaneofibular ligament. I note an intrasubstance split within peroneous brevis at the level of the fibula and indeed there is high signal seen within the fibula itself.
The flexor tendons are normal. There is increased fluid in the tibialis posterior tendon sheath.