Hi About Two months ago, I sprained my ankle at work

Patient

Q: Hi.

About Two months ago, I sprained my ankle at work. I lift heavy stuff all day, and was walking down some steps. It did hurt initially, but I was fine walking on it, and it did hurt that night, but the next day, even though it was certainly very swollen, I found if I didn't swivel on the ankle, or turn too sharply, I could work fine. This was only a temporary job, and I assumed if I went to see the doctor, they'd tell me to stay off of it, but I was only working for another month or two, and needed to save up my goal amount of money. So I kept working on it. A couple more times, about a couple weeks later, I stepped gently on an uneven surface, and it hurt again (not as bad) but again, felt fine if I didn't swivel on it, This happened again in the last month (not as bad, but kind of an initial shock, and then it was mostly fine). I like to meditate, and I found the only problem is that I can sit cross-legged, or in the lotus position on it. I just assumed once I stopped working I could stay off my ankle, it would heal eventually, and I'd be fine.

About one week after I stopped working, and got off my foot, laid/sat around the house, I noticed my knee was starting to hurt, this bothered me, and having read enough, I knew it was due to my ankle. But why would it hurt AFTER I stopped exercising/using my ankle? Then another week, now my hip hurts with the same dull/slight burn/ache. Now I'm really worried. The ankle is more flexible than it was, but now I have knee and hip aches. I thought that the effect of ankle and hip pain was like a long-term effect of a poorly healed ankle, but I was increasing my ankle flexibility and resting on it, and it seems now, when I do the ankle exercises I've seen online, my hip pain flares up more.

My real question is, if it was *just* a bad sprain, if my ankle heals, am I *doomed* to hip and knee joint pain? Or is there hope?! This was only two months ago and my ankle isn't entirely healed yet. I don't have health insurance so I'm not sure who I should see about it. I just HAVE to know if there is still hope because it's keeping me up at night thinking about having severe pain for the rest of my life. I'm terrified I really screwed up. I have to know if there is hope for me to return to having a normal, pain-free leg, with normal flexibility, and the ability to do yoga and sit and meditate in comfort.

Symptoms:  Pain in knee(occasional) and hip(more often lately) and ankle (negligible, not entirely healed)
Doctor

A:   Hello
Thanks for posting your query at ATD
I have gone through your history, ankle pain can cause altered gait eventually leading to hip or knee pain but since your ankle is healing, pain has decreased, and its flexibility has increased so hip pain cannot be attributed to it.
Clinical examination of the hip joint will be required along with xray of pelvis with both hips for initial evaluation and later further investigations will be required depending upon the findings of the initial investigation.
You seem to have pathology of hip with referred pain to the knee joint. My recommendation is to visit your local orthopaedic surgeon for clinical examination.
If you have any more doubts or seek further information. Feel free to discuss.
Regards

Comments / Follow Ups

Patient: But it has to be? I might have hurt my ankle worse than I thought, but I've never had knee or hip pain. Then when I get off of my ankle and rest, I start having knee and hip pain. I wasn't doing the exercises that first week, just letting it heal. But it was stiff. That's when my knee and hip started hurting. I'm 99% sure it's related to my ankle. If you can just *suppose* for a second, that it is related, what then?
Doctor: Hello
I have gone through your history again but the minor ankle injury like sprain cannot cause pathology in the hip. For any such pathology to develop the changes in primary region in this case ankle has to be gross enough to affect the biomechanics of the lower limb causing secondary changes in the hip region.
Ankle trauma here is a preceding incidental finding or a concurrent pathology. Minor ankle sprain is not a etiology for hip pathology.
For this reason, I'm recommending clinical examination to look to for subtle signs of impaired functioning of hip.
Considering it to be due to ankle injury, the pain and stiffness should be temporary and less than as compared to the ankle but in your first query you have mentioned that the flexibility of ankle is more but now knee and hip aches have started. Its almost two months since ankle injury and second twisting injury 1.5 month back which have healed but knee stiffness which resulted from rest of a couple of weeks have not reaolved after almost a month. Such situations don't happen. Patients bed rest after trauma for weeks to month, hip stiffness/pain is rarely seen, knee stiffness occurs but not bothersome, its the ankle which becomes stiff to thw extent that it cannot be corrected by force under anesthesia. Therefore my advice is to get clinically examined and if you still have any doubts, please write to us.
Regards
Patient: I'm saying the ankle has not totally healed. It still hurts if I turn it inwards, or say, if I lightly "mock" the way that it was injured, as in turn my foot in, and put pressure down on the side of my foot, that very much hurts.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421486/
Doctor: As per the article there is decrease in muscle strength, I'm strictly commenting on the dull ache/burn ache which you have mentioned in your first query. Decrease in muscle strength or weakness of muscle on examination is a different symptom then pain.
Weakness in hip abductor is a known cause because plantar flexor of the ankle and hip abductors are synergistic muscles during gait.

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