Ankles suck
November 12, 2019 7:58 AM   Subscribe

My ankle hurts again. Last time I saw a doctor about it, they said it was a sprain or strain, but I have no memory of any specific injury whenever this happens. It occurs a few times a year and now it is my left, but usually it is my right ankle. What could this be?

I am limping and walking slowly. This usually lasts for 2-3 days of pain after two days of weird feelings in my ankles. The pain is mostly in a horizontal line at the front of my ankle just above my foot. Two years ago, they took x rays to make sure the bones are all okay and gave me a walking boot that seemed to make the healing process slower and caused other pain in my toes. I take ibuprofen or acetaminophen, but it doesn't do much.

Normal treatments for minor injuries don't seem to do much or make things worse:
Rest - it is worse in the morning and better in the afternoon when I have been walking around on it
Ice - doesn't seem to do much
Compression - I am afraid to to do this since it seems to be a common trigger
Elevation - Same as rest, it seems worse after I elevate
Heat - last night I used a heating pad in the evening and it hurt badly before bed. Then I woke up twice from discomfort.

The main causes I can figure out are really tight socks or shoes and if I let my ankle hang unsupported of a chair or when crossing my legs.
posted by soelo to Health & Fitness (10 answers total) 1 user marked this as a favorite
The doctor also ruled out gout since it comes and goes.
posted by soelo at 8:00 AM on November 12, 2019

My latest flare of inflammatory arthritis focused on the ankle. I let it go for months because it came and went like you describe. It was worse in my left ankle but also sometimes affected the right. It was worse in the morning and would clear up by end of day. Sometimes it felt better if I was overly active vs resting. I saw an orthopedist thinking I had injured it (I’m very active) and he assured me he saw no signs of my arthritis. He did not run blood tests.

Finally a random finger joint swelled for no reason and I went to see rheumatologist... it had been my arthritis all along. I have no other symptoms of arthritis.

Since you don’t have a diagnosis, I’d request a screening for inflammatory arthritis - things like c reactive protein , sed rate, rh factor. Your doctor should be open to ruling that out.
posted by Tandem Affinity at 9:55 AM on November 12, 2019

Do you have tight peroneal muscles?

If you put your hand on the outside of the top of your lower leg (around the outside from your shin, below the boney bits on the outside of your knee) & dorsiflex (flex ankles to tows move upwards towards your knee) or evert (pull toes outwards 'duck foot' like) you should be able to feel those muscles flex and move under your fingers.

Are they tight and sore if you dig into them? When these aren't working well you can get referred pain at the bottom of your tibia (across the crease as you mentioned) as well have a greater tendency to rolling or spraining your ankle. It's also a pretty dense muscle fibre that weight bearing makes slow to recover. This combination of weird sensation, slow recovery, significant pain and lack of imaging can make them difficult to assess if you don't see someone who works with soft tissue.

It may be worth seeing a Physical Therapist or Registered Massage Therapist.
posted by mce at 10:03 AM on November 12, 2019 [2 favorites]

When my ankle hurts I find it really helps to stretch my calf. Mine also hurts less when I've been walking around vs sitting. It makes me suspect that the problem is less with my ankle and more with tight muscles further up the chain.
posted by velocipedestrienne at 11:50 AM on November 12, 2019

Have you been to a podiatrist? Feet and gait are their thing so they might be able to hone in on any issues with the way you’re moving and offer orthotics that would help.
posted by penguin pie at 12:07 PM on November 12, 2019

Did your doctor actually check your uric acid levels? I had gout (on and off) for years before getting properly diagnosed. I went through at least 3 doctors before someone figured it out. My earlier doctors ruled it out for similar reasons (and that I was a vegetarian in my 20s).
posted by thedward at 2:14 PM on November 12, 2019 [1 favorite]

> Did your doctor actually check your uric acid levels? I had gout (on and off)

I would second this. I had gout attacks in my ankles for years that "came and went" very similarly to yours, but were never recognized because ankle is not a typical presentation for gout. Finally, when the gout presented more typically (bright red swollen big toe joint) we retrospectively realized what all the other attacks were.

So, not saying it IS gout but just one possibility to consider.

In my ankle, what it felt like to me was that I suddenly had a sprained ankle, even though I definitely hadn't twisted it or anything that would normally cause a sprain. It was last for several days or maybe a week and then spontaneously get better.

Also, if you get your uric acid levels checked, the results will likely come back in normal range even if you have gout. The question, however, is whether they are **near the high end** of the normal range. Most people who have gout seem to fall into that range--upper end of normal. Only the very worst cases are actually well above normal range for UA.
posted by flug at 6:40 PM on November 12, 2019

Do you get a headache or anything else associated with migraines like stomach aches or light, smell sensitivity? About three years ago, I switched from having dizziness and exhaustion as my main "I'm going to get a migraine" symptom to ankle pain. Now my ankles ache badly before a migraine comes on. It's not a common pre-migraine symptom but it's not unknown. Not much helps except migraine-specific meds. Elevation and massage is nice.
posted by dorothyisunderwood at 9:08 PM on November 12, 2019

soleo: just reviewing your notes and wanted to chime back in again:

Several people have noted things (presumably if not explicitly) from personal experience that can/have caused these kinds of symptoms, were challenging to get treatment for and might be non-trivial to diagnose.

So I'm back to offer a piece of advice that I should have put front & centre: keep a log

You've got a great list of interventions, observed outcomes and probable triggers. Keep taking notes. If this ends up being something inherently uncommon (or an unusual presentation of something more on the beaten path) a good log will help a persistent practitioner to form a plan for you. Also; any "process of elimination" gets a lot easier to manage if you can do some of the elimination.

I offer this not as a doctor (or any other medical professional) as I am not. Just good advice that has proved itself as good practice for a wide range of intermittent challenges.
posted by mce at 8:00 AM on November 13, 2019 [2 favorites]

Thanks for all the suggestions. I saw the same doctor and she put me back in the boot (I did not know it worked on both feet) and ran some blood tests. The boot seems to be helping.
posted by soelo at 8:06 AM on November 15, 2019

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