Q: My husband is a healthy 65-year-old that normally works out at the gym. He eats right and spends the time needed to try and stay in shape. He was helping me reposition and twist a rather heavy outdoor fountain when he said he felt a pop in his ankle. That was about two months ago. Now he is developing a limp and has pain in his ankle most of the time; We went to Med Express right after it happened but nothing showed up on his X-ray.
After a few more weeks of limping and pain, we were referred to a local ankle/foot surgeon. He had him get an MRI done and the results came back as tendinitis. My husband has been in physical therapy for about three weeks now but it really isn’t helping him. We just can’t help but think that something else happened when he felt the ankle pop. Does this sound like tendinitis? Should we be asking for some other type of test. Is it even possible to have a mis-read MRI?
He’s taking Naproxen, using ice, wearing a Velcro brace and doing therapy. Can you suggest anything else for him. His limp is affecting other parts of his body when he walks now.
A: Let’s begin with the easy portion of your husband’s dilemma. Yes, doctors (including radiologists) are human and can make mistakes. The MRI could have been read incorrectly. Whether or not it is tendinitis remains to be determined but that probably wouldn’t be my first guess. Tendinitis is actually inflammation or irritation of a tendon that can occur anywhere in the body but is most commonly observed in the wrists, heels, elbows and shoulders. For example, baseball pitchers complain of pitcher’s shoulder a/k/a tendinitis, tennis players suffer from tennis elbow a/k/a tendinitis, basketball players and distance jumpers suffer from jumper’s knee a/k/a tendinitis. Symptoms may include pain generally described as a dull ache, swelling, and tenderness. Your husband could have injured himself twisting but most individuals with tendinitis find it appears because of repetitive movement and stress on tendons such as hammering, painting overhead, golfing, and the like. Tendinitis can often be diagnosed through a physical exam of the affected area. X-rays will rule out other conditions.
A condition known as ankle impingement occurs when the soft tissue around the ankle is pinched. Strong ligaments support and surround the ankle joint. The most common injury is one at the front of the ankle that supports the outer edge of the ankle. This type of impingement can ordinarily be diagnosed through an MRI that will reveal a subtle fracture, stress fracture or stress reaction of the bone. The MRI will likely be ordered by a health care professional prior to having a bone scan performed, if deemed necessary.
Popping on a one-time basis such as that experienced may be from a muscle or tendon tear that may have resulted in tendinitis from an ankle sprain/strain, as opposed to repeated popping from subluxing of a joint. A sprain results in injury to a ligament, while a strain is injury to a muscle or tendon. Sprains often occur when a person makes a rapid shifting movement with the foot firmly on the floor because the ankle commonly rolls outward while the foot turns inward. While less common, the reverse can occur. A strain results from twisting or pulling the muscle or tendon, or from improperly lifting heavy objects that over-stress muscles. Diagnosis will be through examination, X-rays and possible MRI.
I’ve only listed a few possibilities but your husband should visit a top-notch orthopedic specialist who can examine him to determine the exact cause of the problem. He should take any films that have been done so they can be reviewed through a new set of eyes. His pain has lasted too long and something is being overlooked. I cannot even recommend ordinary remedial procedures since he’s been doing them all along, so make an appointment and be guided accordingly.
