MRI confirmed tore ATFL but most of my pain is somewhere else

My x-rays showed no break and my MRI showed a torn ATFL. And I have a negative bone scan. I have pain on scale of 4 to 6 during the day and 8 to 10 at night and have not been able to walk on it since September 6. Most of my pain is on the upper lateral malleolous/distal fibula and radiates up my leg. I can put foot down but cannot do a heel to toe roll without extreme pain. I have an appointment next week with an ankle OS. I have yet to receive an ankle exam. Is it possible we’ve missed something? I know peroneal tendons can be missed by MRI and I was also thinking the anterior tibial fibular ligament could be causing the pain. I’ve read ultrasounds can find other tears that are missed on MRI. Can you suggest anything I should ask at my dr. appointment next week?

4 Responses

  1. Foot-com

    Hello and thank you for the follow up information. In patients such as yourself it is difficult to assess your pain or causes of your pain without actually examining you. When a patient has ankle pain we always want to rule out ligament tears, osteochondral lesions, impingement syndromes, torn ligaments, joint effusions, nerve traction. These are all the diagnosis that I would be assessing you for, but again without seeing you I cannot say exactly what it is. I would try to pin point a little more specifically when you feel the pain, what movements aggravate it and what alleviates the pain. I hope this helps somewhat.

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    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

  2. Foot-com

    Ive had 2 pt sessions so far. And my pain has decreased about 50%. My pt showed me how much laxity I have. In plantar flexion, its like its on wheels back and forth and I have a little laxity on dorsiflexionon on inversion and a little on eversion.. Is it normal to have this much laxity with just an atfl tear? Or is this an accumulation of all my sprains and fractures? And I realise every doctor will have a different opinion, but what are the key indicators or criteria used for surgery? The degree of laxity concerns me. Am I too anxious about this? Is this normal and will i be fine? Thanks for your time. I realise long conversations are not the norm for surgeons, so your time spent on this is impressive and appreciated.

  3. Foot-com

    I just got back from ankle os. He said I still have a lot of pain and swelling so hard to evaluate. I was sent to pt for 6 weeks to fwb and further evaluate then. Im a little confused because he didnt really say anything besides sprain and torn atfl which I already knew. He did say he thought my pain was from peroneal muscle fatigue not tendon. And that he doesnt want me in a boot but a brace. Hmmm. Time will tell I guess. Is there a better way to frame my question so I get a direct answer?

  4. Foot-com

    Hello and thank you for your question. I have often seen peroneal tears missed by MRI that were later surgically corrected. A torn AFTL typically does not present as pain above or behind the ankle bone. If you have persistent swelling you would want to rule out any joint effusion or chondral defects, as well as any possible traction to the nerves around the lateral ankle.

    Depending on whether or not you have pain on resisted eversion would the Orthopedist suspect a peroneal tear. I hope this helps!

    Good luck.

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    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

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