View Full Version : Chronic ankle sprain
I rolled my ankle badly during IET last fall, breaking my 5th metatarsal and sustaining a partial tear of my ATFL. The ankle turned black and swelled to the size of my knee. I was able to complete the next six weeks of training with the help of splinting and lots of Tramadol.
Unfortunately, I left Ft. Jackson without an LOD (didn't know to ask), which was the first thing that my unit asked for when I returned to them. To make a long story short, I ended up spending $4000 out of my own pocket for an MRI and extensive physical therapy. I was released to full activities this summer, and spent a lot of time gearing up for OCS and the rest of my pipeline. There was still some instability in the joint, but I was able to run without pain and my run times were good.
Two weeks ago, I reinjured the ankle at Ft. Benning and am probably being med dropped from my current course. I am not receiving very good care here, and have not been able to get a referral to a real physician, so I am guessing that I will have to get this taken care of after I am released. I can manage day-to-day activities in boots with only moderate pain, but cannot run on the ankle.
My goal is to do whatever is necessary to get back to 100% and drive on.
Has anyone had experience with reconstruction of the ATFL, followed by a return to duty? I've done a lot of research online, but very little of it seems geared to someone in this line of work.
Also, do any of you have advice on accessing care when not on active duty status? I live seven hours from my unit and expect this to be a struggle. I don't want to get myself into another bad situation by not knowing the right questions to ask.
Thanks very much for your help.
Eagle5US
11-25-2007, 13:21
You say you aren't receiving very good care there and can't get to see a "real physician". What does that mean?
They cannot deny you the opportunity of sick call, where you would see a provider.
Physical therapy is a common option, but they will not send you to Ortho unless you have already failed a trial of duty after physical therapy and PT thinks a surgical consult is warranted.
If they send you for a surgical consult, it will more than likely be for a Bronstrum procedure. It can be open (incision) or closed (arthroscopic)
I have had this procedure after multiple grade II and III sprains / fractures (which resulted in a grossly unstable ankle) and have returned to active duty.
Hope this helps.
Good luck
Eagle
Eagle,
Thanks for the info. I am glad to know that a full recovery is possible after the procedure.
I have been to physical therapy at TMC twice and seen two different physical therapists. They both noted instability upon examination, but have refused physical therapy and/or an ortho consult, with the rationale that I won't be here long since I am ARNG. Their advice was to take ibuprofen and worry about care once I get home.
You say you aren't receiving very good care there and can't get to see a "real physician". What does that mean?
They cannot deny you the opportunity of sick call, where you would see a provider.
Physical therapy is a common option, but they will not send you to Ortho unless you have already failed a trial of duty after physical therapy and PT thinks a surgical consult is warranted.
If they send you for a surgical consult, it will more than likely be for a Bronstrum procedure. It can be open (incision) or closed (arthroscopic)
I have had this procedure after multiple grade II and III sprains / fractures (which resulted in a grossly unstable ankle) and have returned to active duty.
Hope this helps.
Good luck
Eagle
Eagle5US
11-25-2007, 14:07
Eagle,
Thanks for the info. I am glad to know that a full recovery is possible after the procedure.
I have been to physical therapy at TMC twice and seen two different physical therapists. They both noted instability upon examination, but have refused physical therapy and/or an ortho consult, with the rationale that I won't be here long since I am ARNG. Their advice was to take ibuprofen and worry about care once I get home.
Got it-
Unless there is a medical hold company or a med holdover status that you can become a part of for your course. They are pretty much correct as far as how students are referred back to home station for treatment.
Rehab of an ankle is generally patient driven. That is to say - here are the exercises, here are the big rubber bands in various colors, do your work as instructed, use the ice and ibuprophen and go from there. Typical rehab timeline for a grade II ankle is about 12 weeks. If you are going to be a med drop from your course...and there is no med hold availability...the it is indeed unreasonable to expect them to hold you there for your rehab.
The degree of instability is what determines the need for a surgical consult. Additionally, most orthopods I know will not operate on an acutely injured joint that doesn't have an incorporated fracture. The tissues are angry and proper "healed anatomy" showing the exact level of defect is not appreciable with everything all still swollen and ugly inside.
To give you an example, mine was (finally) operated on when I could stand up and literally invert my foot so that the sole of my foot was skyward.
In the meantime...search your memory for the rehab you previously accomplished and begin doing so as soon as possible. Wear a high topped shoe / boot whenever possible for ankle support. DO NOT play basketball or any other sport in running shoes (other than running), and I would suggest a lace up ankle brace (like this one I wore for years) (http://www.orthobionics.com/aso/aso-ankle.htm) or even a newer model(like this one from Donjoy (http://www.orthobionics.com/donjoy/ankle/rocket/rocket.htm) when you are involved in activities where you may have a tendency to hurt yourself. Know that wearing these types of orthotics ALL the time will considerable WEAKEN your ankle and is not recommended.
HTH-
Eagle
Thanks once again, Eagle. Like a lot of soldiers, I get impatient when it is unclear how long I will be out of commission. I am taking a deep breath and reconciling myself to at least 12 weeks of PT and recovery, longer if the exercises and NSAIDS don't work.
Since this is such a common injury, here is a link to the AMEDD treatment guidelines, including exercises to assist with recovery: http://www.mamc.amedd.army.mil/referral/documents/musculoskeletal_trt_guidelines/Ankle%20sprain.doc
Eagle:
Thanks for the info on sprains. My son got a Grade III sprain of his ankle while home on his R&R. Two tours in Iraq and he goes and gets hurt playing paintball! He was recalled back to Ft Bragg after notifying his unit of his injury. He had to report in last Monday and they were supposed to set him up with a CT scan to see if there was any bone damage. Don't know the results of the scan, but he's been declared non-deployable and probably won't complete his second tour since he was part of the initial surge.
Could an injury of this type take him off jump status? He's really concerned since he re-enlisted in 2005 to go to jump school and get assigned to an airborne unit. I know from the "old days" that these kinds of injuries, when reported during sick call, sometimes caused people to be reassigned to a non-jump unit or pulled your 'P' or 'S' suffix.
Eagle5US
11-26-2007, 00:27
Eagle:
Could an injury of this type take him off jump status? He's really concerned since he re-enlisted in 2005 to go to jump school and get assigned to an airborne unit. I know from the "old days" that these kinds of injuries, when reported during sick call, sometimes caused people to be reassigned to a non-jump unit or pulled your 'P' or 'S' suffix.
The Ortho staff at Bragg is well versed on repair of paratrooper's ankles and knows quite definitively that ones who want to be pulled from status are few and far between.
True Grade III sprains almost always incorporate a fracture causing the joint surface between the lower leg and the foot to be unstable. Surgical intervention by the bone mechanics can do wonderful things. It will be up to the orthopod as to whether it is "safe" for him to return to / stay on status based on the amount of damage that is found. Better to be off status and be able to play with the grandkids than be on status for 3 more years and be caned for the rest of his life.
I know WE never thought of it that was (and I am sure he doesn't either right now)...
I wish him the best of luck.
Eagle
I've had an injury similar to yours before. It took me about a month to get back enough stability to start running again and that was with a brace.
The Reaper
11-26-2007, 07:52
Little war story here.
I broke my back in '86.
My board eligible Ortho at Womack wanted to fuse T12-L2, and immobilize T11-L3.
Civilian ortho consult (and competent military Orthopod) said cast and release.
Womack Ortho said the vertebral body of L1 would collapse and leave me paralyzed if I did not have the procedure. He also said that they would take the instrumentation out later so that I could return to SF duty, which he later admitted was a lie.
I declined the procedure.
I spent 18 more years on jump status and it never stopped me from doing anything, or caused any significant problem, other than a little occasional tingling and numbness.
Moral of this story?
Don't listen to the first doc you get an opinion from, especially if he is a board-eligible Orthopod, trying to make certification while practicing in a risk-free, zero litigation environment.
Second part is to always keep an eye out for the long term outcome, and take care of yourself like you are going to make it to 100 years old. You wear that machine out at 50, the next 50 are going to be filled with a lot of pain and suffering.
Finally, military parachuting is not the zero-risk ride at Disneyland. People at Bragg are injured almost every day jumping and in fact, several are killed doing it every year.
TR
..........Finally, military parachuting is not the zero-risk ride at Disneyland. People at Bragg are injured almost every day jumping and in fact, several are killed doing it every year.
TR
Besides the fun outweighs the risks involved. :D
BTW, I'm jumping tomorrow and pray for another hard landing, it's the soft ones I get all bent out of shape on.
Eagle: Thanks for the info on procedure from your POV. Good to have a good staff of medical pro's around to use as the sounding board.
jatx: suck it up and don't get bold by trying too hard. I've got a soldier that won't listen and does PT in his own time because he's on profile and can't run (with me around, I own him from 0630 to 1630). Then he breaks his ankle, and tears ligaments instead of the normal sprain. Besides, you should be a overhead arm clapping and push-up freak. Continue thinking positively....you'll be just fine.
Just a quick bump to this thread for the benefit of others with chronic ankle injuries.
I did eight weeks of intense physical therapy this spring, which mainly succeeded in increasing my pain levels so that I could not sleep at night. After an additional eight weeks of rest and steroid injections, I am getting the modified Bronstrum procedure performed on Tuesday. It will be an open procedure and will also include a full arthroscopic exam of the joint, which is full of scar tissue and bone spurs.
Learning everything possible about the injury is an important part of effective self-advocacy, especially if you are the type (like me) that always under-communicates pain levels. I had the help of a surgeon who was an ex-SEAL and family friend - he understood where I was coming from and spent about four hours going through my MRI with me and pointing out problem areas that the radiologist missed. This allowed me to have a much more robust discussion with my orthopod.
Since this is such a common (and under-treated) injury, I will update this thread as I work on getting back up to full speed again.
Update again for those who have/will have similar problems.
Surgery was May13th. Coordinating care through MMSO was a bear, but I ended up with a great surgeon who happens to be the foot/ankle guy for the Portland Trailblazers. The ligaments were in much worse shape than he anticipated based on the MRI and physical exam.
Typical treatment, best I can gather, is a full splint for two weeks until stitches come out, followed by three weeks in a hard cast (for a total of five weeks NWB) and four weeks in a cam walker.
I had my stitches out at two weeks, transitioned straight to the cam walker and resumed normal bipedal ambulation this week (week 6). I am back to swimming laps and can ride the exercise bike with a good tape job.
The worst part of the whole experience was getting my meds right. For the first week, I was on two Norco every four hours, which was just too much for me and made me pretty sick. After that got sorted, it's been smooth sailing. :cool:
Glad to hear you're doing well jatx!
AngelsSix
06-29-2008, 20:50
Wow,
I guess I got lucky. But then, my ortho guy was a civilian. He actually did a terrific job, but then he tried to med board me out!! Weird. I told them at the board to take a hike and that I wanted to be returned to full duty. I was back on full duty about 14 weeks after I had to have the surgery on my foot. Apparently, I had broken it at some point, it had healed and I had to get it RE-broken (definitely worse the second time). At any rate, the doc did good work, and thanks to him I can function fine now. I was in the Navy at the time, however. I have noticed that since I got to Bragg the caliber of the medical treatment has gotten a little shabby. Just my .02.
I did the whole, cast, walking cast, robot leg thing too.....that was fun!!:rolleyes:
I suffered what the ER DOC called a severe Class 2 sprain, during SUT. This was Apr 28th. I have been rehab'ing since then. I have a return date to SUT in approx 2 weeks. When I run I have a little soreness and pain during and after. I did my first ruck yesterday it was 5 miles, 45lb, dry, ruck. After the ruck my ankle hurt bad enough that I was limping. This lasted for about 3 hours. With what the rucks weigh in SUT I need to be able to carry alot more weight, alot longer. I'm going to ask the PA for a shot in my ankle to help during SUT. I've used up my 90 days recovery time so more time is not an option. Any ideas or experience, that could help speed up my recovery would be appreciated. The Doc has me doing toe pointing standing on one leg and calf raises. They helped alot at first but they don't seem to be helping anymore. Also they have me on motrin 3 times a day.
uboat509
07-27-2008, 10:36
I am currently at JSOMTC reclassing from 18C to 18D. Back in Feb I managed to roll my left ankle twice on the same road march, the second time put on my butt for a while unitl the pain subcided enough for me to gimp my way out to where a truck could pick me up and take me to the TMC. It is now late July and that ankle is still unstable despite my efforts and for some reason my right ankle has started bothering me again even though I sprained it nearly five years ago. On top of that I have had bursitis in my right shoulder and tendonitis in both elbows from Jiu Jitsu. In the sixteen years previous to my coming here to reclass I have had a total of one sprained anlke, and I was running on that again in just over two weeks. It appears that I am falling apart. I wonder if it is the water :).
SFC W
I am currently at JSOMTC reclassing from 18C to 18D. Back in Feb I managed to roll my left ankle twice on the same road march, the second time put on my butt for a while unitl the pain subcided enough for me to gimp my way out to where a truck could pick me up and take me to the TMC. It is now late July and that ankle is still unstable despite my efforts and for some reason my right ankle has started bothering me again even though I sprained it nearly five years ago.
I hope that you are going for an ortho consult and MRI. Extra damage was done and my recovery was slowed due to lower-level providers failing to provide the correct treatment and referrals.
Even if you do not have a tear, your proprioception will be the last thing to come back following multiple sprains. My doc quoted somewhere between 1-2 years after all other healing has taken place. Nerves take a long time to heal and, until they do, you will be at greatly increased risk of reinjury since the brain doesn't "know" precisely where your foot is. Balance drills can speed things up a bit.
As for your right ankle, are you limping? A change in gait can put extra stress on the opposing side, as well as the hips and spine. 18 months of pretty minor limping has left me with a bulged disc - you don't want that!
If you are on Bragg, you might pay a visit to the PT clinic and get some instruction in taping your ankle properly. There are methods (i.e. "stirrups") which are low bulk and do not restrict blood flow, allowing you to do what you need to do in boots.
Good luck - feel free to PM.
uboat509
07-27-2008, 13:09
That's the weird thing about it, I'm not limping. My left ankle isn't in constant pain, I just roll it a whole lot easier than I used to. I have no idea why my right ankle would start playing up again. It's not a huge amount of pain or anything, I just find it odd that it started bothering me at all, coming especially as it did at roughly the same time as the bursitis and tendinitis in my arms and shoulder. As for getting to the clinic, the 18D course doesn't leave a lot of time for that (or anything else for that matter). If it is still a problem, I will see someone when I get back to Carson. Thanks for the reply, though.
SFC W
I will try to post a pic of the tape job that I use, maybe it will help you.
I followed up with my surgeon last week, and was disappointed to learn that the suture anchors from my previous Brostrom procedure have failed. There is renewed laxity and significant edema and swelling, although I have not had a reinjury event. There is apparently not enough healthy tissue remaining to reattach the ATFL using sutures. Although I am walking normally, the ankle does not tolerate running, jumping or twisting movements.
I was told that the only remaining alternative is a repair involving the harvest of a hamstring tendon, which will then be used to bypass the blown ligaments on the outside of my ankle. Recovery was quoted as 6 months minimum, more likely 12 before I am running and jumping again.
Does anyone here have experience with this procedure? I am specifically interested in perspectives on the prognosis and pluses/minuses to using a cadaver tendon instead of having my hamstring carved up.
Also, the doc says he is going to send me home with a catheter and pain pump (which I've never had before) instead of using oral pain meds. I'm thinking that this is a good thing, since it will keep a steady level in my bloodstream, but would appreciate thoughts on this, as well.
Thanks guys.