"It's no big deal," I would say. "I'll go home, wrap it, ice it, stay off it a few days, it'll be fine."
Until the time it wasn't.
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When I get up in the morning, I take off a set of braces. They lace and wrap, limiting my range of motion during the night. I wear another brace over the right one, keeping my foot flexed. It prevents me from getting plantar fasciitis again, and helps with the contractures that keep trying to form in my calf and hamstrings on the right side. I take off the overbrace in bed, since I can't walk in it, and brush my teeth and wash my face before I sit down in the chair in the office and take off my night braces. While I sit and write that morning's journal entry, I leave my ankles bare so the skin can breathe. There is a discernible line on lower calf and below the ball of my foot where the braces end.
Then I put on my socks and my day braces. The left one is a sleek, athletic looking thing of neoprene and elastic, with hard polymer shells to embrace my ankle bones. The right one is like the night braces, since the left side isn't quite so bad yet. And I go about my day. Night braces and day braces, and the only time I walk barefooted are the few steps to get in the bathtub and out of it.
I don't take showers, since I would have to stand barefooted in them for too long. I have a very limited amount of standing time and walking time, and I have to divide the grocery shopping into three parts so that I can still walk enough to put the groceries away when I get home.
How did it get this bad? Follow me under the swirl....
Part of the problem undoubtedly was genetic. I am doublejointed and have loose ligaments in all my extremities. I also am on the autism spectrum, and have the general coordination issues that often go with that. Add in ADHD, and you have a recipe for sprained ankles.
I also came from a family where complaining about your injuries got you out of nothing, and there was always some work to be done. Are you bleeding? Can you stand? Shake it off, and keep going. Animals need tending, grass needs trimming, house needs cleaning, people need fed, errands need running.
And then I married, and lost my parents' union auto workers insurance. Once you don't have insurance, even if you realize that that ankle is a little worse than sprained this time, you don't take it to the doctor. Tape it up. It takes longer to heal, it hurts for longer. Oh, well. Life hurts. That's the nature of things. Besides, the doctor will want to get a CAT scan, and who has money for THAT out of pocket? Now I'm waiting to see if I can get Medicaid and finally get this resolved.
So what did I do?
I have tears in my anterior talofibular ligament.
Huh? Let's break it down. It's the ligament in front (anterior) connecting the talus and the fibula. The most common type of ankle sprain occurs when the foot is inverted too much, affecting the lateral side of the foot. When this type of ankle sprain happens, the outer, or lateral, ligaments are stretched too much. The anterior talofibular ligament is one of the most commonly involved ligaments in this type of sprain. Approximately 90% of ankle sprains are inversion injuries.
I did all the right things when I did sprain it, except for going to see a doctor. I keep compression bandages at home, and I elevated it and iced it, and rested as much as I could. But eventually I tore it so far that it always hurt, and I was constantly falling off my feet, because my ankles were unstable.
So what's next? When I get insurance (we are currently waiting to hear if we are approved for Medicaid) I'll see an orthopedic surgeon and learn just how badly I messed it up. I'm pretty sure the solution is surgical; if braces and yoga (to learn balance and stretch and tone muscles) were going to do it, they would have done it by now. The type of surgical correction that I'll have depends on the severity of the injury to the ligaments.
In some cases the stretched out ligaments can be “tightened” through arthroscopy. Small incisions at the front of the ankle allow for the introduction of a camera and a special instrument that will “shrink” the ligaments, tightening them. In most cases the ankle joint will need to be opened over the area of the ligaments in order to visualize the ligaments themselves. The ligaments can then be repaired by placing them back onto the bone in their anatomic position. In some cases a small metal anchor will be used to anchor the ligaments into the bone. This repair will tighten and strengthen the ligaments again. In some cases when the ligaments are too weakened or destroyed to repair, cadaver tendon is used to create new ankle ligaments. This tendon is routed through the bones of the ankle to reinforce the ankle.
Recovery will depend on what they do, but will probably be in the 8-12 week range, with physical therapy and gradually increased weight bearing. I won't ever get normal range of motion back, but in braces I don't really have that now, so there's nothing new there. I would have a lot less pain. Plus, I'd be able to wear the riding boots my friend gave me.
If you have chronic ankle instability or work on your feet and want to protect yourself from a twisted ankle, I wholeheartedly recommend the ASO Ankle Support Orthotic. The set I am replacing was worn every day for two years, and is only now having some of the binding coming off. They wear hard and do their job very well. And $30, while not cheap, is still less expensive than the surgery I now need.
So what's paining you today? Let's talk about it.