THE CLINIC: MRI Sooner Than Later for Ankle Assesment

QUESTION:

I sprained my ankle severely four months ago when I

landed on someone's foot while playing basketball.  Even though my ankle

swelled up, there was no ligament damage or fractures.  However, a week later, the inside of my ankle began to really hurt. All of the

other pain and swelling has subsided, but I have this pain on the inside of

my ankle, and the trainer from my team says it’s cartilage damage.  They have

me taking pain medication since we are about to start the playoffs, but I

was wondering if there was anything else I could do before this problem gets

worse.  If I wear a boot, would that help also?  Our

trainer said that after the season I should rest a month or

two and it would get better. If not, then I would get an MRI and go from

there.  He said I don't need an MRI now because it’s cartilage

damage. 

 

Tamara Wright

Reseda, CA

 

ANSWER:

With pain persisting at

this point after your injury I agree that you likely have a cartilage injury

or what is sometimes called an osteochondral defect—which is damage to the

cartilage as well as the underlying bone.  An MRI is an excellent way to

assess this, but I'd recommend  doing it sooner than later.  A walking cast, or “boot,”

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

 

 

ANSEWR:

My first question would be how do they know it is cartilage damage?  A regular

x-ray may show the injury but cannot determine the extent of the injury.

In persistent ankle injuries like osteochondral fracture or 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 four months, I would say you were 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 surgery (arthroscopic). My advice would be to get an MRI ASAP

either in Europe or once you return.  Then get evaluated by a podiatrist who

specializes in sports medicine or an orthopedic surgeon who specializes in

foot and ankle injuries.  

 

Patrick J. Nunan, DPM

 

 

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(RUNNING & FITNEWS^® September/October  2008• Volume 26, Number 5)