Medical Question - Ankle Pain

[jyl]

A medical question.

For about the last five years, I've occasionally had brief periods of pain and stiffness in my ankles. The first time, both ankles were very painful, somewhat swollen, couldn't flex much, couldn't bear weight when flexed but still could stand when ankle not flexed, I was unable to walk without crutches. That lasted about 2-3 weeks, my PCP referred me to a rheumatologist, by the time I got in to see the rheumatologist the condition had gone away and he was unable to make a diagnosis. He speculated about psoriasitic (sp?) arthritis. X-rays didn't show anything.

Since then one or both ankles have acted up maybe 2X each year, but in a much milder fashion - one or both get painful and stiff, somewhat achy, usually not particularly swollen, I walk with a limp - but it goes away after a day or two. Ice, heat, Tylenol/Aleve all help, but anyway the condition is brief. The episodes seem vaguely correlated to over-exertion and to stress, and don't require any specific injury event - it's not like I'm "twisting" the ankles.

Anyhow, I now have another episode going on, this one has lasted since last Friday, left ankle only. Its slowly improving, but is taking longer than "usual" to go away. I limp around like an old man, try to stay off my feet, and have finally resorted to borrowing my wife's car as pushing the 911's clutch is painful - doable, but it hurts and the ankles feels worse afterwards.

My question basically is, is there anything wrong with my simply dealing with this and waiting another week to see if it goes away, instead of going to see a doctor? I don't believe in running to the doctor for everything, so unless anyone tells me I'm hurting myself more, I'm not eager to make an appointment.

Thanks for any thoughts.

[widgeon13]

Could it be gout?

[Steve Viegas]

If it is Gout, you will want to see a doctor during an attack. They can then pull the fluid out and test it for crystals. They cannot test for Gout if you are not having an attack.

[TSNAPCRACKLEPOP]

pix?

are you double cluthching, or driving different cars from time to time?

really, this is to vague to dx online.

[jyl]

Doubt pics would show anything - the ankle looks normal, maybe just slightly swollen.

Yes, have been switching between the 911 and the Vanagon, and double-clutching - but only drive 8 miles/day, like 15 minutes a day.

I know this is too vague to diagnose from my inexpert description. I'm more wondering if any of the possible causes that come to mind are conditions that require me to go to a doctor in order to avoid some permanent damage.

In other words, suppose it were gout - if you don't seek care during a short episode (a week long or less) but simply let the episode pass, does that typically make the underlying condition any worse?

[TSNAPCRACKLEPOP]

gout is usually more in the distal joints, not the ankle itself

[futuresoptions]

Good luck man, twisted my left ankle a little over two years ago, went through all the therapy and surgery to no avail. They sent me out the door like all was well when my workmans comp was up, and I am still in alot of pain. For me I just think the doctors and lawyers milk the system... Hope you get more help and resolve than I did.... I talked to someone on this board that had their ankles bonded. If I don't clear up pretty soon, this might be a road that I decide to take... Good Luck

[Steve Viegas]

Gout is a build up of Uric (SP?) crystals in the joint. If this goes untreated, it will act like sand in the joint. That being said, I had gout for almost 20 years before they figured out what it was and I am still moving about.

Gout GENERALLY starts in your extremities and moves to larger joints as it progresses. By the time mine was caught it was in my knees and elbows (as well as the joints leading up to those points).

Hope you don't have to go through what I did.

[wm711]

http://www.arthroscopy.com/sp09017.htm

[Nathans_Dad]

Gout is a crystalline arthropathy, which usually does affect the distal joints like toes but can affect other joints as well.

It sounds like either gout, pseudogout (which involves calcium crystals instead of urate crystals) or simply osteoarthritis.

I would talk with your doctor, simple X Rays of the joint are usually the first step. If you happen to come in during an attack and there is a joint effusion (excess fluid in the joint) then it can be tapped with a needle to look for crystals and try to make the diagnosis. If it is osteoarthritis then you can often see signs on the X Rays.

Hope that helps.

[Tobra]

Originally Posted by TSNAPCRACKLEPOP

gout is usually more in the distal joints, not the ankle itself

yup, and this ain't gout, it is usually unilateral, hot and painful to touch, pseudogout is much more common in the knee, also tends to be unilateral as I recall, calcium hydroxyapatite crystals or some such thing. I suppose it could be gout, start drinking cherry juice and if it improves, my money would be on gout, but it just does not sound like it to me.

What did your bloodwork show? There are some specific tests to order, gout might not show up if not during acute attack, but if your HLA B27 antigen is positive, it is positive, though this is not 100% diagnostic. If it is episodic in nature, sounds like this is the case, you ought to get blood work while you are in the midst of an attack

How old are you, what else is wrong with you, how is your skin.

Could be osteoarthritis(wear and tear) but sounds more like an auto immune type deal to me, rheumatoid disease maybe, or something seronegative. With psoriatic, you usually see skin and/or nail manifestations.

How is your stomach? Can you tolerate aspirin, ibuprofen, that sort of stuff. Typical treatment for a lot of this sort of thing is symptomatic. Alleve, two twice a day with food ain't bad;

Mark, you got a fine subtalar joint fusion there, does the head of that screw bother you? Looks like it might impinge on the tibia. Do you wear a heal lift to even you up? Typically get a bit of a limb length discrepancy with something like that

Tobra,
Had bilateral fusions, so I'm as even as I ever was. The screws did bother me so I had the docs pull them.

[jyl]

Thanks, guys.

I'm 45 y/o, take medication for blood pressure and cholesterol but otherwise nothing in particular is noticeably wrong with me, my skin is fine and never had any noticeable psoriasis. Also never had any other autoimmune issues as far as I know. My mother has bad rheumatoid arthritis, otherwise no family issues with arthritis. I can take aspirin, etc, fine - currently taking Aleve and/or Tylenol for this, it helps a bit. Have never injured my ankles, maybe a sprain or two in my youth. I don't recall what my bloodwork showed back when I sought care for the attack 5 years ago.

Sounds like I should see a doctor while the episode is still going on, I guess. Rained like hell tonight, I had to climb up to the treehouse to put a tarp over some stuff and it hurt a lot, plus almost fell down the ladder, made me realize how much several days of this is bugging me.

The Frankenstein pic is scary, Mark. What happens with airport metal detectors?

[jyl]

Well, finally went in to see a foot/ankle specialist.

The ankle has gotten better, but is still swollen and limited range of motion and can't raise self up on ball of left foot, I still limp and have to move slowly.

He stuck a largish needle in my joint and drew out some (synovial?) fluid, plus took x-rays, plus ordered a blood test, examined my nails and skin (looking for psoriasis?), felt the joint motion, etc.

So I look forward to finding out what is going on. He said x-rays show small arthritic changes in the joint but he seemed to think they were pretty minor.

[pwd72s]

John, I'm no MD...and please don't laugh when I say this. Have you ever charted your episodes with barometric readings?

I guess what I'm saying is..welcome to the Oregon winter thing. Both Cindy & I suffer joint pain when the barometer drops, usually accompanied by a sou'wester storm.

[Tobra]

when the barometric pressure falls, the joints will tend to swell, as pressure falls outside joint faster than it can fall in the joint. That is how rheumatoid pt can predict the weather, it is not an old wives tale

When you try to rise up on ball of L foot, is it painful on the inside of your ankle primarily? tell your foot and ankle guy about this, may indicate posterior tibial tendonitis

[jyl]

Arrgh, I had not thought about a weather connection. Making me feel old here.

The pain, when trying to rise on ball of foot, is kind of on the inner side of the heel just aft of the ankle joint.

[HardDrive]

Do you exercise? What kind of shoes do you wear? Do you sit at a desk for long periods of time?

[Tobra]

Originally Posted by jyl

Arrgh, I had not thought about a weather connection. Making me feel old here.

The pain, when trying to rise on ball of foot, is kind of on the inner side of the heel just aft of the ankle joint.

that is the spot, posterior tibial tendonitis, ice 15 min out of each hour while you are awake, this is a problem you want to be aggressive in treating, don't go walking around without shoes, pick up some superfeet arch supports at your local running shoe store, they will take some of the strain off that tendon. You do NOT want that tendon to fail.

Avoid the "Good Feet" store like a high mileage 5 owner Audi without any service records