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Thursday, December 27, 2007

Severe ankle sprain, chronic ankle pain and cortisone injections

Dear Gary,
You have a great website. You must feel proud and blessed to have helped so many injured people. May God bless you.

Long story short, severe right ankle sprain in July 2007, 4wks. later MRI shows 2 torn ligaments and sinus tarsi syndrome, sl. marrow edema, alot of pain w/ weight bearing and less at sleep, Oct. 2007 MRI shows slight diastasis of tibia, and one remaining torn ligament, worsening of sinus tarsi syndrome, have had pain everyday, worse w/ increase in weight bearing, can be pain free while sitting, pain at night varies, off and on. Saw the lead instructor at the XXXX school of podiatry, he was doing very conservative treatment, but my workman's comp. agent and family was annoyed at my slow progress and inability to walk much (due to increased pain w/ ambulation). So I saw another doc , ankle/foot surgeon from XXXX University Hosp. He focused on the 4mm? diastasis occurring by my fibula, pulling away from my tibia, and wanted to do surgery and insert a syndesmotic device which is a screw in the tibia, then a screw in the fibula, then a wire that pulls and keeps the bones together, which will "fix my ankle". I read up on this device, and being overweight, I am not a "good candidate". In Nov.15th, 2007, I saw another ortho. ankle doc at XXXX Hospital. He did stress fracture xrays and then injected my ankle w/ 4cc =1cc of cortisone agent and 3cc of lidocaine=4cc injection. My gut told me that's alot of fluid, and where will it all go in the ankle area? Well it went in OK, he injected under guidance of an xray, (not ultrasound). I was in pain that day and severe pain that night. Called the next day, his nurse told me I was having an injection flare, very common. Keep taking motrin and ice it. I did so all weekend. The next week the pain continued, I called and called, saw him the next Monday11 days after the injection, I also was running a low grade temperature everyday 99.3-99.8, even with motrin everyday. He said I did not have an infection. The site looked sl. swollen, like the fluid was under the skin, but it 'Burned" so bad, off and on, the pain was worse than before I saw him. He told me he was baffled and I should see his partner. He took more xrays, which showed nothing new. He did not address the fever, as they did not have a thermometer to check my temp. He gave me a note to be off work for 1 week, as I was now back in a walking cast and on crutches. It hurt too much to walk. The next week, Dec. 3rd I returned to work, non weight bearing, desk duty, 4 hours a day only. He wants me to begin physical therapy now. I did nothing this week but work.

I am scared. I still have a really intense deep burning that occurs usually after I have been on the foot abit, in the area he injected. It's a very intense burn, that stops me in my tracks, and I have to shake the foot as it feels like it's on fire. Then it passes, and I can breathe. What do I do now?
How can I flush or minimize the cortisone/lidocaine from eating up my nerves or ligaments? Have increased my fluids.

Photo: An example of a cortisone injection gone wrong

I never had this burn, until after the injection. My low grade fever broke on Thursday Dec.6th...98.8 and 98.3. I had no other illnesses, no UTI, not a sniffle. I am healthy except for this ankle.
Also, I have sprained this ankle before, in 2002, and again in 2005. I was off work 1 week in 2005, then returned to weight bearing duty quickly, and did PT....found PT little to no help. During my last session, the P.T. had electrodes that burned my skin, so I skipped any future sessions and seemed to heal OK. My ankle would hurt if I was on my feet all day, hiking, or really walking non-stop for 8hours. Then I would take motrin and it was better.
Gary Moller replies:
I appreciate your deep concerns about what is happening and the pain you are suffering right now (I fractured my own ankle a few months ago and have suffered several bad sprains over the years).
Ankle sprains, even severe ones tend to resolve of their own accord if given the time. An ankle sprain can remain painful for a year or longer. I am very much in favour of conservative treatment and giving the body time to do its healing work. To administer cortisone injections into the painful site just months after the injury is not conservative. Even if there are signs of slight instability between the tibia and fibula, I would still play a waiting game rather than operate. It just makes no sense to chemically excise structural tissue that is already weakened through injury. Having said this, please discuss your needs with your doctor, including what is advised in this article, thank you.

The body has a remarkable capacity to heal of its own accord. All you have to do is help it by providing the right conditions such as:
  • Going on a weight loss programme if overweight - not by starvation but by a natural wholefoods diet plus exercise
  • Exercise in the form of aquajogging and aquaerobics - the partial weightbearing and hydraulic pressure burns calories, stimulates the citrculation, reduces swelling and strengthens the muscles
  • Glucosamine and chondroitin 3 times daily to assist joint healing
  • 2,000 mg vitamin C daily to assist healing and to reduce inflammation
  • 2,000 mg daily of fish oil with vitamin E to assist healing and as a natural anti-inflammatory
  • MSM (Methysulfonylmethane) daily. MSM is a natural anti-inflammatory and aids healing.
  • Massage the area using effleurage and depp tissue massage techniques. The effleurage can begin immediately following a sprain and the deep tissue massage which can be painful can commence gently within 3-4 days of the injury and become more "forceful" as the weeks turn into months.
  • Soak daily for up to an hour in a very warm Epsom Salt bath. The Magnesium and Sulphur aids healing and relaxes and the heat improves circulation.
All of these products are available from my website store
These measures may assist with giving you some relief from the pain associated with the cortisone that was injected. You might like to add a quality natural vitamin B complex to the supplements, since any deficiency in these will add to muscle and nerve pain and you don't want that.

Please go easy on the Motrim which has a raft of nasty side effects if taken over a prolonged time, including liver and kidney damage. Try as much as possible to put up with the pain and to use natural remedies like those listed above that improve health, rather than risk compromising it.

Your history of repeated sprains indicates that you have disrupted the nerve proprioceptors in your ankle. A weak ankle is more to do with the way your reflexes respond, rather than to do with weak muscles. As you ankle pain subsides, you need to commence doing balance exercises. You need nothing other than to be bare foot and practice balancing on one foot and then the other. Once you are proficient, progress to balancing on the ball of each foot. Once you master this, practice these with your eyes closed. Do these daily and you will develop strong and stable ankles.Charlotte, I hope that this advice helps somewhat for what is a painful injury that is very slow to recover from at the best of times. Whatever has been done from the cortisone is done and dusted and the focus must now be on recovery. Having said this, I would still be going back to the Dr that injected you and ask what he/she is going to do for you (So long as it does not involve more drugs or invasive treatment), since the cortisone appears to have made you worse, rather than better.
Take your time, give healing time and do not panic. Time heals eventually.

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