THE CLINIC: Cartilage Damage Can Feel Like Stress Fracture

Wed, 10 Oct. 2012 - 2:36 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I play basketball on a team and I suffered an ankle injury a few months ago which was diagnosed as a bad sprain. No ligament damage was found and I managed to avoid a fracture. However, a week later, the inside of my ankle began to really hurt. All of the other pain and swelling has subsided, but I am left with  significant pain on the inside of my ankle. Is this cartilage damage? What can be done about it? I’m not sure what this means in the long term, but for now it feels like I have a stress fracture. Is it possible I reinjured it just by walking around? Would wearing a boot help? 

 

David Marvenouski

Jacksonville, FL

 

ANSWER:

A regular x-ray may show the injury but cannot determine the extent of the injury, or whether it is in fact cartilage damage. In persistent ankle injuries that involve both damage to the cartilage and the underlying bone, also known as osteochondral injury, what happens is that there is bleeding,  then an area of dead bone forms just under the cartilage. This can cause extreme pain and lateral erosion in the joint. The other alternative could be a loose piece of cartilage that broke off and is causing pain in the joint. Both of these problems are best evaluated on

MRI. 

 

Since your injury has been present for several months, I would say that you are past due for an MRI. Typically with athletes that we see, if the pain persists more than three to four weeks or it is an in-season injury, we get MRI studies. A boot in between games and practices would help some. Steroid injections or anti-inflammatories such as ibuprofen would also help. I have had good success using electrical bone stimulators which is a non-painful device that you wear while sleeping or rest. It helps to regenerate new bone in the area. 

 

While one or two months rest may help the problem, it may not. Sometimes these injuries require arthroscopic surgery. My advice would be to get an MRI ASAP. 

 

Patrick J. Nunan, DPM

West Chester, OH

 

ANSWER:

With pain persisting at this point after your injury I agree that you likely have a cartilage injury or osteochondral defect. An MRI is an excellent way to assess this, but I'd recommend doing it sooner than later. A walking cast (the “boot” you refer to) can sometimes help decrease the pain but will also promote weakness and stiffness of the ankle; therefore it is not good for more than a couple weeks of use. Unfortunately I have seen these injuries improve with rest only to flare right back again after activity is resumed.

 

Paul Langer, DPM

Minneapolis, MN

 

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

 

 

(RUNNING & FITNEWS® November / December 2011 • Volume 29, Number 6)




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