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

[EKS]

But am I worried about clots? 

 

Yes, you are.  One of the symptoms of a blood clot is that the pain gets worse instead of getting better.

[Ethel Mertz]

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.

 

Ah, that makes sense then. But still raise the issue just in case.

[Katy]

Only you know if the pain is really getting worse and not better.  But I can tell you for certain that if my friend had the symptoms you describe upthread and refused a hospital, I'd nag her until she went or I'd assume she was lying about the severity of the pain for attention.   You asked for advice because you had an instinct that this injury is different than the others.  I'm telling you it sounds like it is.

 

You go to the ER.  They'll bring you in to an exam room, bring a tech with an untrasound machine probably right to your exam table and she will trace the veins in your ankle and look for clots..  Generally clots in your lower leg aren't super dangerous but the fact that the pain is increasing more than three days after an injury is a huge sign of an issue. Compartment syndrome is another issue- where instead of just a strain, a muscle is injured so badly it swells up inside the muscle and cuts off ciruclation to the muscle, which causes enormous tissue damage and can be fatal.

 

If it were just a sprain or a ligment issue, even a severed ligament, chances are it would follow this pattern:  It would be sore, tender, and the pain would slowly increase over the first three days as the swelling increased.  You might have low-level, throbbing pain, about a three on a ten point scale, that never stops for a few weeks.  If you moved or put weight on it or twisted it in the wrong way the pain might spike up to a level 8, and then slowly drop back to a three while you rest the joint.  After the initial three days the swelling would slowly start to decrease over the following weeks, but it might be months before it's completely better if it's sprained, and you might need surgury if it's a ligament issue. The point is, unless you reinjure it by twisting it the wrong way, at this point the pain should be slowly decreasing, not getting worse.  If your pain is not following that pattern, something else is going on, and you owe it to your children to take care of their mother.

 

Don't take my advice though.  If the pain is really increasing that much, call back the urgent care clinic you visited and leave that message for the doctor.  Chances are they'll have you come in, they'll check for signs of impeded circulation, and then they'll send you to the ER for an ultrasound and MRI.

[AimeeM]

I will definitely go back to the urgent care and ask him for an MRI referral if it doesn't get better.

Going to the ER, to obtain an MRI, isn't something I'm willing to do unless it gets significantly worse. Every single time one of us has been in our ER, we end up bringing something back (illness-wise) to the children - including medically fragile, one fully functioning lung, DS5. The last time it was pneumonia. 

 

With that said, it IS feeling better! I jokingly told DD the other day that if the urgent care visit did nothing else, it seems that JUST when I bite the bullet and go to the doctor for something, it starts feeling better by the next day, so it will have been worth the trip.

 

I think it's feeling better because I've A) babied it, and B) taken the ibuprofen that the urgent care MD told me not to take :p

He prescribed Norco and told me wanted me off the ibuprofen completely for a few days because of the around the clock dosing I had been taking of the ibuprofen prior to seeing him. I was honest with him and told him that there was no way in Hades I was going to dose myself on a narcotic pain killer all day while I was responsible for the kids, but that I would cut off the ibuprofen after DH was home in the evenings, use the pain medication then, and if the pain was serious during the day, that I would knock back my ibuprofen dosing to 400 mgs, and alternate with a dose of the pain meds, if DD was available to help with the boys.

 

The pain started to get more bearable yesterday evening at some point. I thought it was just the pain meds, but this morning when I woke up I actually didn't hurt at all until I put weight on it, and even then the pain was much less than it had been. By late afternoon today, the pain had decreased even more.

 

He did put me in a boot. I'm being a good girl and wearing it, but it is SO HEAVY. And itchy. The heaviness and how slippery the bottom is, is making me afraid that using it will lead to another injury - we have all hardwoods and I've slipped more times than I can count :p

Only you know if the pain is really getting worse and not better.  But I can tell you for certain that if my friend had the symptoms you describe upthread and refused a hospital, I'd nag her until she went or I'd assume she was lying about the severity of the pain for attention.   You asked for advice because you had an instinct that this injury is different than the others.  I'm telling you it sounds like it is.

 

You go to the ER.  They'll bring you in to an exam room, bring a tech with an untrasound machine probably right to your exam table and she will trace the veins in your ankle and look for clots..  Generally clots in your lower leg aren't super dangerous but the fact that the pain is increasing more than three days after an injury is a huge sign of an issue. Compartment syndrome is another issue- where instead of just a strain, a muscle is injured so badly it swells up inside the muscle and cuts off ciruclation to the muscle, which causes enormous tissue damage and can be fatal.

 

If it were just a sprain or a ligment issue, even a severed ligament, chances are it would follow this pattern:  It would be sore, tender, and the pain would slowly increase over the first three days as the swelling increased.  You might have low-level, throbbing pain, about a three on a ten point scale, that never stops for a few weeks.  If you moved or put weight on it or twisted it in the wrong way the pain might spike up to a level 8, and then slowly drop back to a three while you rest the joint.  After the initial three days the swelling would slowly start to decrease over the following weeks, but it might be months before it's completely better if it's sprained, and you might need surgury if it's a ligament issue. The point is, unless you reinjure it by twisting it the wrong way, at this point the pain should be slowly decreasing, not getting worse.  If your pain is not following that pattern, something else is going on, and you owe it to your children to take care of their mother.

 

Don't take my advice though.  If the pain is really increasing that much, call back the urgent care clinic you visited and leave that message for the doctor.  Chances are they'll have you come in, they'll check for signs of impeded circulation, and then they'll send you to the ER for an ultrasound and MRI.

 

[sewingmama]

My DD broke her ankle with no swelling or real bruising. Typically what you described is a break in the outside bone of the ankle..like a piece gets chipped off or cracks. It's a very common injury caused by rolling the ankle. DD got it when she slipped on a plastic bag on the floor and her ankle hit the table leg.

 

Generally they don't plaster it. They wrap it tight for support and tell you to use crutches till it doesn't hurt anymore.

 

Make sure you keep off it.

[Guest]

My DD broke her ankle with no swelling or real bruising. Typically what you described is a break in the outside bone of the ankle..like a piece gets chipped off or cracks. It's a very common injury caused by rolling the ankle. DD got it when she slipped on a plastic bag on the floor and her ankle hit the table leg.

 

Generally they don't plaster it. They wrap it tight for support and tell you to use crutches till it doesn't hurt anymore.

 

Make sure you keep off it.

 

Agree. I broke that bone completely off and it had to be surgically repaired. I tried to do too much too soon (I was 15) and I still have trouble with it to this day because I didn't let it heal properly.

[3in9th]

I had two stress fractures on my ankle last year. My symptoms sounded very much like yours. X-rays showed nothing, but an ultrasound with an orthopedic dr. was able to get it sorted out. Ibuprofen, Aleve, etc. will DELAY bone healing. Tylenol is recommended. Have your Vitamin D checked. Mine was very low. In the meantime, RICE- rest, ice, compression, elevation.

 

If you are off your ankle for a while does it feel better? Does it hurt if you stand for more than 10 minutes straight. Does it ache when you get it hot (like in the bath or shower)?

[AimeeM]

I had two stress fractures on my ankle last year. My symptoms sounded very much like yours. X-rays showed nothing, but an ultrasound with an orthopedic dr. was able to get it sorted out. Ibuprofen, Aleve, etc. will DELAY bone healing. Tylenol is recommended. Have your Vitamin D checked. Mine was very low. In the meantime, RICE- rest, ice, compression, elevation.

 

If you are off your ankle for a while does it feel better? Does it hurt if you stand for more than 10 minutes straight. Does it ache when you get it hot (like in the bath or shower)?

It feels better if I heat it. A hot bath was my friend the other night.

Right now it doesn't hurt much at all if I'm off it - which is a big improvement over a couple days ago (when it was throbbing pretty consistently, even off the foot). If I put pressure on it, in a certain way, it still hurt pretty badly when I'm on the foot, but not all the time now, and not when I'm off the foot. The pain, even when it's there now, is a pinch... it feels like a bad twist now. It WAS unbearable... like "shoot me now, somebody, please" unbearable. 

The day after the injury, it didn't hurt much. In fact, I thought it was a normal ache for me (my ankles and knees ache in certain weather, or during certain seasons), then it became progressively worse (much, much worse), and now it's on the other side of decline - the pain is going down. 

It still itches, but the pain is decreasing at least.

[Katy]

I'm glad you're feeling better.  It does sort of sound like a stress fracture.

[AimeeM]

If it sounds like a stress fracture, should I consult an orthopedic doctor instead of going back to the urgent care for an MRI referral? My insurance doesn't require a referral, so as long as the specific orthopedic doctor doesn't require a primary referral, I could probably get into one.

 

ETA: I'm leaning towards wanting the MRI, even though the ankle IS starting to feel better. Frankly, I need an updated one for my knees, too, at the request of my OBGYN (who can't act as my primary, but when I consulted him about my knees, he suggested I see somebody about getting an MRI for that, before I had my appointment with a new GP, just to have everything on file and ready).

[Guest]

I would definitely go with an ortho since it isn't a hassle to get in. They are better equipped to rule out or confirm anything, and they get rid of the middle man.

[Guest]

I would definitely go with an ortho since it isn't a hassle to get in. They are better equipped to rule out or confirm anything, and they get rid of the middle man.

[Katy]

Oh gosh.  I don't know.  Except for school I think I only spent two shifts on an orthapedic floor, ever, and both days they had overflow bariatric patients, not orthapedic ones.  I would call an orthapedic doctor and ask to speak to a nurse, and ask for their advice...  Maybe one of the people who have had that injury can tell you more specific info.  The only stress fractures in our family have been in the feet in a military training situation.  There was no surgery involved, but that doesn't mean that advice would extrapolate to an ankle.

[jenn-]

I would definitely go with an ortho since it isn't a hassle to get in. They are better equipped to rule out or confirm anything, and they get rid of the middle man.

 

I disagree unless the ortho has a MRI machine in office (ours does).  DD's ortho took repeated x-rays of her foot, but that would have never ever shown the break that the MRI caught because it is a bone in the middle of all the other ankle bones.  The way the MRI takes the slices, it became visible.  The x-ray would have never caught the partially ruptured tendon either although the podiatrist that looked at the x-rays after we fired the ortho showed me where the inflammation could seen as a cloudy spot on x-ray.

[AimeeM]

I disagree unless the ortho has a MRI machine in office (ours does).  DD's ortho took repeated x-rays of her foot, but that would have never ever shown the break that the MRI caught because it is a bone in the middle of all the other ankle bones.  The way the MRI takes the slices, it became visible.  The x-ray would have never caught the partially ruptured tendon either although the podiatrist that looked at the x-rays after we fired the ortho showed me where the inflammation could seen as a cloudy spot on x-ray.

I'm not sure of ours has an MRI on site... but they are attached to the hospital, and refer out to the outpatient center, which houses the radiology department. So, as long as I can get an MRI that way (and since the GYN specifically requested updated MRIs for my knees, that shouldn't be too difficult), instead of going through the crowded, public ER, where I'll be exposed to any number of things considering the flu season (and the almost-at-capacity nature of our hospitals right now, from what I hear), I'm okay with having to go scheduled through the outpatient center. I can ask my GYN about who he would recommend, too.

[jenn-]

I'm not sure of ours has an MRI on site... but they are attached to the hospital, and refer out to the outpatient center, which houses the radiology department. So, as long as I can get an MRI that way (and since the GYN specifically requested updated MRIs for my knees, that shouldn't be too difficult), instead of going through the crowded, public ER, where I'll be exposed to any number of things considering the flu season (and the almost-at-capacity nature of our hospitals right now, from what I hear), I'm okay with having to go scheduled through the outpatient center. I can ask my GYN about who he would recommend, too.

That would be good then. Avoiding the germ factory of the ER is good. You might want to spend a few minutes researching the orthopedists in the area. Some of them specialize in different areas of the body. Not that they can't treat all parts but if you can find an ankle/foot specialist, it might help.

[AimeeM]

That would be good then. Avoiding the germ factory of the ER is good. You might want to spend a few minutes researching the orthopedists in the area. Some of them specialize in different areas of the body. Not that they can't treat all parts but if you can find an ankle/foot specialist, it might help.

Good point. I didn't think about them specializing in certain areas!

[Alessandra]

I love orthopedists! Unlike ERs, they don't do $$$ CBCs and pregnancy tests as a routine. My practice has doctors that specialize in feet, in knees, and so on. Office does not have MRI, but they have x-Rays, ultrasound, and PT.

 

I hope you find someone you like.

[Guest]

I disagree unless the ortho has a MRI machine in office (ours does).  DD's ortho took repeated x-rays of her foot, but that would have never ever shown the break that the MRI caught because it is a bone in the middle of all the other ankle bones.  The way the MRI takes the slices, it became visible.  The x-ray would have never caught the partially ruptured tendon either although the podiatrist that looked at the x-rays after we fired the ortho showed me where the inflammation could seen as a cloudy spot on x-ray.

 

Guess I was just going off the repeated trips to the ortho my brothers and I had over the years here. Between us we have seen three different orthos in our area and all had MRI in office. Guess I didn't realize that all don't. 

[jenn-]

Guess I was just going off the repeated trips to the ortho my brothers and I had over the years here. Between us we have seen three different orthos in our area and all had MRI in office. Guess I didn't realize that all don't. 

 

Considering I pretty much had to threaten the doctor to get him to put her into the one in his office, I'm usually quite sour about know-it-all orthopedists.  I'm sure that the majority of them are great and wonderful doctors, but ours was an @ss.