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Is it possible it's more than a sprain? (Paging Dr. Hive!)


AimeeM
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The inner ankle (as in, the inner ankle bone - the tibia?) on my right foot is killing me. As in, the pain is making me nauseous. First I thought it was just a strain or sprain; the pain was manageable the first day, but has been getting progressively worse. It is VERY tender to the touch, and feels warm (to me - no exterior warmth, though), and it itches; the "hurt so badly I feel nauseous" only happens when I walk on it/put weight on it, though.

 

Thing is, there's no swelling that I can see. I was always taught (playing soccer and being involved in competitive gymnastics) that swelling meant "go directly to the doctor or ER", but that anything else was probably a sprain. Given, those telling me that were coaches, not MDs :p

 

With that said, I have experienced many, many, many strains and sprains over the years, and none felt like this - none were tender to the touch, never did it become progressively WORSE over the days, and none itched; never has the pain been anything more than ibuprofen and ice/heat could handle. 

 

Silly question to ask the Hive. The reason I do is because I do *not* have an internist or GP right now. I'm waiting for an opening, or for a new patient intake appt a month out right now for a new GP. My only other doctor is my GYN ;) Going to an urgent care (all of which, locally, DO treat/x-ray sprains, etc... but all are filled to bust lately with sick (contagious "sick") patients, and my kids have FINALLY gone a month without serious illness (this has been a ROUGH winter for my minions, especially medically fragile DS5), so I'd really rather not risk bringing something home to them if it's just a sprain.

 

So I guess my question is (after all those words! Lol) - without swelling, can it be more than a sprain? I mean, it can't be broken or fractured... right? When my step-mother broke her ankle, it was DEFINITELY swollen (like, tennis ball swollen).

 

ETA: I do NOT remember, directly, injuring it badly. That isn't saying much, though, since I'm an epic klutz, and very frequently trip over my own two feet, fall, or walk into walls I've known for many years.

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The only thing I can think of is a bone spur on the fibula, because you said inner ankle and very sensitive to touch. 

 

The itchiness could be due to a nerve that's been squeezed out of place into the more superficial part of the ankle.

 

Was there an 'event' that preceded the pain, and is the pain constant?

 

Sorry I'm not much help... just random thoughts.

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Oh gosh, Aimee. I think it's possible you could have torn a ligament. And it's not out of the question that you broke something - or had a bone chip in your ankle. I wonder if you could go to the urgent care thing as soon as they open tomorrow (if you can make it that long, otherwise ER). Maybe you can even put a mask on (they have them on the counter of most MD offices I've been in). If asked, you could explain you aren't sick, but you don't want to take any germs home to a medically fragile child. Hope you feel better soon!

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The only thing I can think of is a bone spur on the fibula, because you said inner ankle and very sensitive to touch. 

 

The itchiness could be due to a nerve that's been squeezed out of place into the more superficial part of the ankle.

 

Was there an 'event' that preceded the pain, and is the pain constant?

 

Sorry I'm not much help... just random thoughts.

Can they do anything for a bone spur? 

 

No, there was no event (that comes to mind - remember... epic klutz, lol) that preceded it that I can remember. I'm sure there was SOMETHING, but I'm also the type of falls and trips around so much that when I'm in the shower and look down at my legs, I'm always a bit surprised by the bruises, because I don't remember walking into anything, or hitting anything, but it's been part of my daily life for so long that unless something literally snapped in my body (bone-wise), I probably wouldn't think much of it.  

 

Yes, the pain is constant. Within 30 minutes of taking advil (800 mg), it's chilled out to "just throbbing but not making me feel like I want to vomit"... but within a few hours of the ibuprofen, that small comfort has worn off and it's back to "somebody shoot me now". 

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Oh gosh, Aimee. I think it's possible you could have torn a ligament. And it's not out of the question that you broke something - or had a bone chip in your ankle. I wonder if you could go to the urgent care thing as soon as they open tomorrow (if you can make it that long, otherwise ER). Maybe you can even put a mask on (they have them on the counter of most MD offices I've been in). If asked, you could explain you aren't sick, but you don't want to take any germs home to a medically fragile child. Hope you feel better soon!

Well, that would... stink. I have torn small things in my knees over the years (when I was younger), but I was younger and bounced back quicker ;) 

 

Gosh, I know I asked, but I really didn't think anything could be broken considering the breaks I've seen on others. My SMs ankle was HUGE within no time of her breaking it. Maybe it is a bone chip. What can they do for that - if anything? 

 

I do think I will go to urgent care in the morning. I really wish I had been more consistent in pressing for a new patient intake sooner. I didn't start looking until recently, because... well, no excuse - I just got busy with the kids, the dogs, and showing the house. Bad Aimee :P

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Can you go to the ER and have it X-rayed? That is probably where urgent care will send you tomorrow anyway, and if you go to the hospital they can also give you painkillers to help you get through the night tonight.

The urgent cares here actually advertise that diagnose and treat (set and cast breaks, even), so I would really prefer that. I can't leave the house tonight, no; DH is traveling and our sitter isn't available this weekend. No family locally. 

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The urgent cares here actually advertise that diagnose and treat (set and cast breaks, even), so I would really prefer that. I can't leave the house tonight, no; DH is traveling and our sitter isn't available this weekend. No family locally.

I don't blame you for waiting if your urgent care is that good! :)

 

Have you taken anything like Aleve for it, and tried putting ice on it?

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I don't blame you for waiting if your urgent care is that good! :)

 

Have you taken anything like Aleve for it, and tried putting ice on it?

Two of the urgent cares here appear to have sports medicine MDs on staff, so that may be why they have the ability to *do* so much. 

 

Hmm. I think there was a reason I can't take Aleve. Nursing - DS2 still nurses. I seem to recall my GYN telling me ibuprofen is okay, aleve isn't. I'm not super familiar with Aleve, though, so I'm not sure why. Aspirin content at all?

 

Yes, I've tried cold and heat. Last night I tried soaking it in a super hot tub, too.

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You are actually less likely to have swelling with a break then a sprain.  Do you have any podiatrists in the area?  Given that it is your foot/ankle area, they should be able to treat.  Some insurances and doctors require referrals, some do not.  It was a podiatrist that caught my daughter's partially torn ligament after an orthopedist repeatedly told her for 6 weeks that it was a "minor sprain" and that she was being dramatic.

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It definitely could be broken.  If you're in that much pain, perhaps you can pump extra,  then go to the ER, get it set, and get some pain meds?  I wouldn't wait for a walk in clinic if I was in that much pain.  Especially if it's getting worse.  There are a few issues that could cause that that are rare, but dangerous.

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It definitely could be broken.  If you're in that much pain, perhaps you can pump extra,  then go to the ER, get it set, and get some pain meds?  I wouldn't wait for a walk in clinic if I was in that much pain.  Especially if it's getting worse.  There are a few issues that could cause that that are rare, but dangerous.

I can't go the ER tonight - nobody to stay with the children. 

 

I wasn't really hoping to hear that it could be a break, but I do appreciate the honest advice that it could be one. I guess it just makes me feel like a total spaz that I could have broken or seriously injured my ankle... and I don't recall getting seriously hurt, lol.

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You are actually less likely to have swelling with a break then a sprain.  Do you have any podiatrists in the area?  Given that it is your foot/ankle area, they should be able to treat.  Some insurances and doctors require referrals, some do not.  It was a podiatrist that caught my daughter's partially torn ligament after an orthopedist repeatedly told her for 6 weeks that it was a "minor sprain" and that she was being dramatic.

We do have podiatrists in the area, and our insurance doesn't require a referral.

If urgent care doesn't come up with anything in the x-ray, I'll call a podiatrist.

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If it starts getting red and hot to the touch, it could be a blood clot.  When I have had them, it hurt the worst when I put weight on my foot especially if I had been sitting for awhile or laying down.  Mornings where the worst.  I would dread putting my foot down.  Blood clots aren't as dangerous in the lower half of the leg but if you notice the pain moving up your leg I would get it checked asap.

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I can't go the ER tonight - nobody to stay with the children. 

 

I wasn't really hoping to hear that it could be a break, but I do appreciate the honest advice that it could be one. I guess it just makes me feel like a total spaz that I could have broken or seriously injured my ankle... and I don't recall getting seriously hurt, lol.

 

 

What would you do if you had a more severe emergency? Are you involved in a church that could help with the kids? Do you have a friend you can call?

 

I know it is hard to see in the fog of mothering young children, but severe pain is a very good reason to go to an ER. Imagine one of your children were experiencing your symptoms. Do for you what you would do for them.

 

 

ETA: Is DH traveling driving distance or plane trip? Any neighbors who could help? Can your sitter give an alternate recommendation?

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Thing is, there's no swelling that I can see. I was always taught (playing soccer and being involved in competitive gymnastics) that swelling meant "go directly to the doctor or ER", but that anything else was probably a sprain. Given, those telling me that were coaches, not MDs :p

 

I believe you've got it backwards.  In my own rather extensive experience with ankle sprains, there will almost always be swelling.  Sometimes huge amounts of swelling.  And then it will gradually recede and the pain will lessen over time.  Sprains typically involve soft tissue, and that's what swells.  Conversely, the people I've known with fractures have frequently not had any swelling.

 

So I would be much more concerned about pain w/o swelling being a break.

 

Some of my sprains have been excruciating -- the kind of pain that OTC pain relievers wouldn't begin to touch, and that ice didn't help.  I post that just to let you know that sprains can indeed be incredibly painful.  (And FWIW I've been told all my life by medical providers that I have an extremely high pain tolerance, so while I always doubt myself I assume those excruciating-to-me ankle sprains truly were very high pain events.)

 

I hope you can get it x-rayed today and get some relief from the pain. :grouphug:

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I'd go to the walk in clinic. I know that's a total pain, but you should have it checked out. Sometimes breaks in the foot have no treatment though.  I had one like that.  They just gave me an ace bandage, walking boot, and crutches. 

 

What about an orthopedist office?  Or do you need referrals? 

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When I tore my post tibular tendon, there was very little swelling with tremendous pain. While you are waiting to go to the dr. RICE - rest - ice, compression, and elevate above your heart. Ice helps more than advil for me. Good luck. 


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Google to see if there are any orthopedic walk in clinics near you. You will get better care from an orthopedist, AND no sick people! Our's has a "convenient care center" just for stuff like this. I've been there more times than I like to share, and they are experts in this stuff. And no flu patients!

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I would head to Urgent care (fastest way for us to get an x-ray) if you cannot get into an Orthopedic Dr.

 

This is NOT something I woud go to a GP or Internest for.

 

A podiatrist would be 3rd on my list (and I love my podiatrist!).

 

Hope you can get some care today. :grouphug:

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As horrible a thought as it is, I want to echo the suggestion of a previous poster that it could also be a blood clot. When you go to the Urgent Care, raise that question with the docs there.

 

As far as what do they do for bone chips -- mine was finally diagnosed after I flunked out of PT and they did an MRI. I had arthroscopic surgery on my ankle.

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What would you do if you had a more severe emergency? Are you involved in a church that could help with the kids? Do you have a friend you can call?

 

I know it is hard to see in the fog of mothering young children, but severe pain is a very good reason to go to an ER. Imagine one of your children were experiencing your symptoms. Do for you what you would do for them.

 

 

ETA: Is DH traveling driving distance or plane trip? Any neighbors who could help? Can your sitter give an alternate recommendation?

Well, generally we have neighbors home, or the boys' Godmother right across the street, but for once the neighborhood appears to be pretty empty and nobody is home. Of course. Lol. 

No friends. Other than DH :)

Worst case scenario is that I wait until tonight. DH will be home. 

 

If I didn't feel a million shades of hesitant about it, I would have DD13 stay with the boys. But, while she's sat with DS5 before for longer periods of time (like two hour costco trips), DS2 is a completely different ballgame and generally requires his own sitter, who can dedicate her attention entirely to him :D

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Aimee - are you feeling any better this morning or is it about the same?

It's definitely not any better. Ibuprofen is wearing off and I'm two hours out from being able to take more. 

DH is going to try to get back as early as he can (he's out of state, though, so it'll take a bit). 

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Call everyone you know.  Get someone to stay with them.  Get thee to a doctor!

There's nobody else, unfortunately. I usually have bases covered between DH, the regular sitter, and the plethora of neighbors we have (several of whom do not work during the day). 

DH is going to try to get home by as early evening as he can - and that's just the best he can do considering the driving distance. 

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It's definitely not any better. Ibuprofen is wearing off and I'm two hours out from being able to take more. 

DH is going to try to get back as early as he can (he's out of state, though, so it'll take a bit). 

 

Are you taking prescription strength ibuprofen (800 mg)? If not, it is perfectly fine to take four 200 mg tablets of OTC ibuprofen every 4 hours.

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Are you taking prescription strength ibuprofen (800 mg)? If not, it is perfectly fine to take four 200 mg tablets of OTC ibuprofen every 4 hours.

Yes. I took 800 mg around 5 am... I think I'm supposed to wait 6-8 hours between doses, right?

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I just googled the dosage: Here's a quote:

 

"The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses). Use only the smallest amount of medication needed to get relief from your pain."

 

This means that you can take it every 6 hours.

 

Read more here.

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I just got home. I went as soon as DH walked in the door. The doctor noticed bruising and swelling in an area "above" what was hurting - I didn't look there because it wasn't the area hurting. He said it isn't uncommon for it bruise/swell in the area surrounding the area that is actually painful.

He did an x-ray. I would have to look at my sheet to see exactly what the dx is. Nothing is completely broken. He does feel that the deltoid or something is torn, but can't dx that with an x-ray. He has me in a boot for 7-10 days, pain medication, told me to lay off the ibuprofen, and to come back for a referral out if it still hurts in 10 days. His main concern is that he doesn't see many injuries, with bruising and swelling in the area I'm bruised/swollen, or injuries to the inside ankle bone area, as much as he does injuries to the outside of the ankle area. 

 

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I hope you feel better soon! If it doesn't get better within 10 days, what does he suspect might be wrong?

He's concerned there might also be a torn ligament (that deltoid area he talked about?), because of where the bruising and swelling were - but that will require more than an x-ray to dx, and fixing it would be a good deal more complicated than the boot.

Considering what he saw on the exterior of the foot, and the x-ray, he doesn't expect it to be better in 10 days - he's just shooting for "not worse". Right now it feels worse, progressively, every day. 

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Do you have health insurance? Is it a good one? If so, I'd push for an MRI to be scheduled. If you wait 10 days you might still have even longer to get treatment because it's not likely you will be able to walk into an MRI machine immediately. This doctor has already told you he isn't experienced with the injury and you need to get into someone that is.

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Do you have health insurance? Is it a good one? If so, I'd push for an MRI to be scheduled. If you wait 10 days you might still have even longer to get treatment because it's not likely you will be able to walk into an MRI machine immediately. This doctor has already told you he isn't experienced with the injury and you need to get into someone that is.

I do have insurance and it's pretty excellent. I can look at getting one scheduled... but again, I have no GP to refer me out. I would need this ER doc to do it. 

He is experienced with the injury - his urgent care center just isn't set up with the technology needed to dx it. 

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I do have insurance and it's pretty excellent. I can look at getting one scheduled... but again, I have no GP to refer me out. I would need this ER doc to do it.

He is experienced with the injury - his urgent care center just isn't set up with the technology needed to dx it.

I'd wait a couple of days and if the pain is still worsening with constant boot wearing, I'd call and ask for the referral. Some tendon injuries really do need more immediate care.

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I'd wait a couple of days and if the pain is still worsening with constant boot wearing, I'd call and ask for the referral. Some tendon injuries really do need more immediate care.

I'm with you there. I assume he can refer out - since he told me to see him back again if it is still getting worse.

Worst case scenario is that I can call my GYN... I believe he would send out a referral, if the specialist NEEDS a referral. I do NOT need a referral for insurance purposes, but some of the local specialists will not see you without one from a primary or other doctor.

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I agree with getting an MRI of this and if something shows up, follow up with physical therapy if indicated. I WISH WISH WISH I had done this when I had a tendon injury instead of trying to just deal with it.

But please don't agree to PT without the MRI first. My daughter's stubborn doctor had her got to PT after 2 wks in the boot. An expensive month of pt later, I had to get the PT involved to final get the MRI done. Turns out most of the exercises they were having her do were doing more damage then good for her particular injury (partially ruptured tendon that runs up the outside of the ankle that triggers another one that goes all the way up to about the knee and a chipped bone deep done in her ankle that will prevent her from ever going up to tiptoe without pain which was a gymnastics career ender).

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Honestly if it's progressively getting worse day by day I would go to the ER, not an urgent care center.  Seriously, it's probably a tendon issue, but you could have an issue with compartment syndrome or a blood clot, and both are very serious.  Go to the ER, repeat over and over that something is wrong and it's getting worse and your friend who's a nurse told you to go to the ER and get an MRI, just to be safe.  If the MRI comes back clear so be it, but so far this isn't okay.  There are situations all the time where people ignore serious syptoms and things get worse.  Three days after injury it shouldn't be continuing to get worse.  It should start slowly getting better after three days.  This is a signifigant sign something is wrong, and this is a good example of how sometimes it's best to just go to the ER if an injury is different than typical for you.  Trust me, I've done enough shifts in the ER to have seen this several times.

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I just got home. I went as soon as DH walked in the door. The doctor noticed bruising and swelling in an area "above" what was hurting - I didn't look there because it wasn't the area hurting. He said it isn't uncommon for it bruise/swell in the area surrounding the area that is actually painful.

He did an x-ray. I would have to look at my sheet to see exactly what the dx is. Nothing is completely broken. He does feel that the deltoid or something is torn, but can't dx that with an x-ray. He has me in a boot for 7-10 days, pain medication, told me to lay off the ibuprofen, and to come back for a referral out if it still hurts in 10 days. His main concern is that he doesn't see many injuries, with bruising and swelling in the area I'm bruised/swollen, or injuries to the inside ankle bone area, as much as he does injuries to the outside of the ankle area.

I'm glad he gave you pain meds. It's a real crapshoot lately bc they're trying to crack down on writing unnecessary scripts for pain meds. I often think they might be becoming too cautious and people in real pain are needlessly suffering.

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But am I worried about clots? I was when there was no outward sign of injury, but the MD at the urgent care pointed out the noticeable bruising and swelling in the area above the painful portion... and I *do* remember what happened now, after DH reminded me about an incident last week. I didn't at the time because I was more angry with the dog, and wet, than I was in pain, but late last week the dog lurched on leash, on a wet/rained out yard, and took me with him - I rolled my ankle tripping over the garden bed, went down, and was dragged a bit by the... enthusiastic, big-for-his-age GSD. The ankle started hurting the next day.

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