I have chronic instability problems with my feet, but over the years I have essentially conditioned myself to cope with these. And by coping, I mean that I have determined that my life is not meant to include high heels or major athletic endeavors. And so here I am, walking at work one afternoon last week. I'm wearing Clarks sandals (comfy, modest, old-lady-esque and slightly orthopaedic). I turn a corner and am heading into the office after a nearly mile-long walk... and I step on the edge of the sidewalk. I was walking behind some folks and had to make way for another group passing the other direction; as a result I stepped with the arch of my foot on the outside of the sidewalk; causing it to roll inward in an "eversion" type injury. These often can cause high ankle sprains, and are the injuries that you see on SportsCenter and go "OH MY GOD" when you see it happen because it looks so grotesque when it happens. I regained my footing quickly, even though it hurt like hell.... I got into the office and propped it up the best I could, but I knew it was hurt pretty badly. Later that evening I managed to make the EXACT same move when walking inside after I got some food off the barbecue. I knew that I had to get it checked out, just to make sure there was nothing broken, but I was a little gun-shy... Whenever I've broken bones, I've not bruised or swollen, so it's always a challenge to explain this to an ER/Urgent care doc who is thinking "textbook" and not realizing that there's some people who don't have outward signs of injuries! Needless to say, I ditched the shoes (naturally, they were the problem, right????). My sister wears the same size shoes as me, so over the years she's been the lucky recipient of lovely, comfy, and (sometimes) expensive shoes that I have deemed as "unstable" to walk in. Lucky girl!
Anyhoo, after himming and hawing around for a few days, I decided that I was time to get it checked out to make sure everything was good. I made an appointment with my favorite podiatrist and finally went in this afternoon. There was a lot of weakness in my ankle joint; also a very positive "Anterior drawer test" which indicated that the anterior talofibular ligament had been damaged. Here's a diagram to show what they do:
Just for reference... the drawer test is supposed to be negative - meaning that there's NO movement in the ankle joint when pulling upward on the heel with the leg fully extended in front of you in a sitting position. My lovely damaged ankle moved better than 1/2 inch. Eww.
The only question was how long it had been since it was damaged... was it the recent eversion injury, or could this stem all the way back to high school? My doctor said that there are 3 options available:
1) ignore the injury completely and manage with anti-inflammatories only. This would result in deterioration of the ankle joint over time and would eventually lead to a complete ankle replacement. His exact words to me were, "I don't do ankle replacements. Build me a better mousetrap and we'll talk, but the junk parts they have on today's market aren't worth using. I'd rather fuse an ankle than replace it."
2) wear a brace (Swede-O or similar) for the rest of my days. NOT an option because those don't fit in most shoes, and I don't wear boots for work! He said that if I was an 80 year old woman that he'd consider this... but since I'm not (and not to mention that I'm a non-compliant brace-wearer by nature), this definitely won't work.
No way, Jose...
3) the best available option is to repair the talofibular ligament with tendon grafting surgery, and potentially also re-create some cartilage using a procedure called "microfracture surgery".