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Bones - ligament tear

Q: I had suffered an ankle sprain in my right foot 2 months back area around the ankle which had swollen to a peach size and there was blood clotting in a 4*2 inch area near the ankle and heel. An X-ray showed no breakage of bones but the swelling was immense. The doctor gave me zinase forte and voveran 50 mg and asked to take rest and hot water therapy for 15 days . I did as I was told, swelling started to diminish but it was still ther even after 20 days and there was slight pain also. I resumed normal routine thereafter but even now when I walk for a while or do some physical work I start feeling a little pain, not severe though sometimes I also feel there is not enough flexibility as it was before also the area still looks like a little swollen. The doctor told me that a ligament connecting my foot bone and leg bone has broken and may be broken ligament is entering ankle joint which causes pain which has to be removed surgically. Can a broken ligament affect my normal routine in future even after surgery. My question is - should I go for surgery? Will the broken ligament affect my normal routine as I am physically very active.

A:From your history you seem to have had sprain of the ankle ligament {though I am not sure of the exact site of the pain (i.e. outer side, inner side, front side or back side) on ankle. The most common ligament torn in the ankle is anterior talo-fibular ligament}. The severity of pain varies depending on the nature of injury. Medically a sprain is tear in the substance of the ligament which links one bone to another bone.

If only few fibers are torn, then the remaining fibers provide stability and healing may be normal with some rest - this is Grade-1 tear.

If large numbers of fibers are torn, then the strength of the ligament is likely to be reduced even after rest and healing- this is Grade - 2 tear. This kind of an injury therefore, needs immobilization in plaster and follow-up physiotherapy and exercises. These patients come with recurrent attacks of pain on trivial injury as the ligament is not strong enough to withstand stresses. Most of these patients may settle with a shoe modification.

However, if the ligament fibers are completely torn - Grade -3 tear, conservative treatment may not be helpful. Some patients may manage with six weeks of plaster followed by exercises but recurrent instability will persist. Patients with complete tear may also have demonstrable instability of ankle. Doing what is called a stress X-ray shows this.

Your case seems to be a case of Grade -2 or 3 tear. Before you decide on surgical intervention, you should have a stress X-ray to confirm the instability and only then go in for surgery. Having said that, your injury is two months old and pain, swelling in ankle sprains normally last well beyond this period. In fact, ankle swelling in patients with sprained ankle sometimes is seen even after 1 to 2 years. Now you could try only ankle and foot exercises. You can be reviewed again after about 3 weeks of exercises.

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