READ MY MRI!! - Do I need ankle surgery?

um.....your MRI says your ankle is totally normal. you should ask for a referral to a mental health professional to help you get over yourself

Background prevalence wrote:

You have some tendinosis and minor ligament damage. Your mri is essentially normal - this is based on your mri findings being very similar to what would be found in asymptomatic people.

You may very well be offered surgery.....if this does occur I think it is reasonable to point out the evidence to support such an intervention is st best limited.

Pretty good concise assessment. The "minor/minimal" issues described may elicit worse symptoms when you try to run than the "minor" adjective suggests. Also, just because the peroneal tendons are not subluxed at rest does not mean that they're not popping over the lateral malleolus or rolling over each other when you run. Also, ask your doc to look for any abnormalities with lateral retinaculum over the tendons, plantar fascia, and in the lisfranc joint. Similar "minor" issues there can feel magnified when trying to run.

Surgery is going to be up to you - how desperate you are to try to fix the 2 yr old issue and how comfortable you are with the surgeon and procedures he chooses. There are a couple different ways to "tighten up" sprained ankle ligaments and as the above poster mentions, favorable outcomes are not guaranteed. It may take some trial and error courses of PT to figure out what exercises strengthen or stabilize the right parts of your ankle, e.g.: maybe your posterior tib is weak, even though you've never felt an issue there. Eccentric work with a band, with manual resistance, or only focusing on soft tissue massage may all affect you differently.

Bottom line: take the actual MRI images (ask for a disk) for a second opinion. Not necessarily because your current doc is wrong, but because it's complicated.

Looks like you'll be taking over for me in the Blade Runner franchise...

I had severe ankle issues until I had to send the whole thing to the cutting room floor.

But learn what I found that would have helped the younger me if I had been able to talk sense to him. If you continue to have pain look into an offloading AFO (ankle foot orthosis). These are not available OTC but through Orthotists/Prosthetists. One in particular I found was superb was from the company Allard. Look into this:

http://www.allardafo.com/front

I wish more people used these for ankle problems before it got too bad.

You should be able to test one at a good orthotist/prosthetist office to see how it feels.

Good luck!

I don't think you are a physician to recommend that and I am a amputee runner btw. That is utter BS and irresponsible unless the feet are ruined. The life of a bilateral amputee isn't easy. It is costly and takes a hell of a lot of work to walk and live life dealing with prosthetics. You have no f'ing idea.

I was diagnosed with hamstring tendinosis (also called tendinopathy) 2 years back. My PT described it as a type of arthritis, in a way, of the tendon/muscle complex. When it flares up, the muscle and tendon can't figure out how to load and then unload (the region is "loaded" during intense activity, and then during the period of rest should slowly unload in preparation for the next activity). A good PT will use dynamic, eccentric exercises and active release therapy (maybe even some dry needling) to get the tendon and muscle complex back into a normal pattern of loading/unloading. I'm probably simplifying the condition and rehab process, but in any case my experience is that with a good trainer/PT, its a very treatable condition.

I appreciate the info! I have actually worked with a PT in the past and he suspected tendinosis of the brevis and longus (the MRI was to solidify a diagnosis, turned out to he was right about the brevis) and actually tried dry needling on the brevis - the nerves were, as he put it, "asleep" and it took a while for the muscle to respond normally to the treatment. It seemed to help with the pain... He also created a strengthening program for me to pursue on my own, which I have been doing. I may contact my PT again and see if more consistent dry needling could be beneficial for the brevis.

I have the disk so I may get another opinion, although my doc and another doc both reviewed the images. They also found a minor growth plate injury near my heel (I'm 17 so that's a bit rare but...), though I don't think that contributes to my pain very often. Mostly my issue is instability during running, though I never end up actually rolling my ankle (not necessarily pain during running, per say)... Peroneus brevis strength is normal, though I am very weak when it comes to inverting my foot (working on that with Therabands)... Thanks for the suggestions!

Give That Man A Hand wrote:

RastaMon wrote:

Radiologist here, agree with one of the above posters, these are essentially normal MR findings in anyone who uses their feet. We have all sprained our ankles at one time.or another, and these minor thickening on the ligaments are incredibly common. Assuming they are truly intact it does not sound like there is anything surgical. And be careful, if you seek surgery some orthopedist who needs to make a boat payment may be happy to oblige, which can lead to its own problems and complications. PT, rest and bracing should be attempted.

Just that simple doc? Then what a waste of money for an expensive MRI. It's no wonder medical costs have gone through the roof with things like this. Sad...very sad.

Haha, we do not order the studies so take that shi* elsewhere. Yes over utilization of imaging does drive healthcare costs and is a huge issue, particularly in the ER. You want to follow the chain back start with our overly litigious society which forces clinicians to practice defensive medicine. And the fact that imaging has in many instances replaced the physical exam, which many referring clinicians no longer have the time or skill to do well. I would say the majority of joint imaging for pain are ultimately for nonsurgical lesions.

And no I do not know if it is that simple, I have not seen the images or examined the patient. But from the MRI interpretation and other clinical factors provided including what sounds like subjective ankle instability in a 17 yo I would caution against surgery at nearly all costs.

To another poster, the orthopedist boat payment is a joke, but in healthcare it is often seek and you shall find, which may not be the appropriate measure.

Finally, we can absolutely see nerves on MRI, and structural abnormalities which cause neuropathies, as well as secondary findings such as denervation of the muscles. The description of the issue from the OP does not sound like a nerve issue whatsoever.

RastaMon wrote:

Radiologist here, agree with one of the above posters, these are essentially normal MR findings in anyone who uses their feet. We have all sprained our ankles at one time.or another, and these minor thickening on the ligaments are incredibly common. Assuming they are truly intact it does not sound like there is anything surgical. And be careful, if you seek surgery some orthopedist who needs to make a boat payment may be happy to oblige, which can lead to its own problems and complications. PT, rest and bracing should be attempted.

Just that simple doc? Then what a waste of money for an expensive MRI. It's no wonder medical costs have gone through the roof with things like this. Sad...very sad.[/quote]

Haha, we do not order the studies so take that shi* elsewhere. Yes over utilization of imaging does drive healthcare costs and is a huge issue, particularly in the ER. You want to follow the chain back start with our overly litigious society which forces clinicians to practice defensive medicine. And the fact that imaging has in many instances replaced the physical exam, which many referring clinicians no longer have the time or skill to do well. I would say the majority of joint imaging for pain are ultimately for nonsurgical lesions.

And no I do not know if it is that simple, I have not seen the images or examined the patient. But from the MRI interpretation and other clinical factors provided including what sounds like subjective ankle instability in a 17 yo I would caution against surgery at nearly all costs.

To another poster, the orthopedist boat payment is a joke, but in healthcare it is often seek and you shall find, which may not be the appropriate measure.

Finally, we can absolutely see nerves on MRI, and structural abnormalities which cause neuropathies, as well as secondary findings such as denervation of the muscles. The description of the issue from the OP does not sound like a nerve issue whatsoever.[/quote]

I like the cut of this guy’s jib. RastaMon, with solid advice like that, I would gladly help out with your boat payments.

RastaMon wrote:

Haha, we do not order the studies so take that shi* elsewhere. Yes over utilization of imaging does drive healthcare costs and is a huge issue, particularly in the ER. You want to follow the chain back start with our overly litigious society which forces clinicians to practice defensive medicine. And the fact that imaging has in many instances replaced the physical exam, which many referring clinicians no longer have the time or skill to do well. I would say the majority of joint imaging for pain are ultimately for nonsurgical lesions.

Knock if off with your "holier-than-thou" attitude! And if you're even a real M.D., then you work for a system that is now he *3rd* leading cause of death in the U.S!!! Doctors cause so much iatrogenic damage it's unbelievable - so don't preach about an over litigious society until you can put your own house in order first! And face it, Big Pharma runs the show. Doctors treat only the symptoms of ailments & diseases with pharmaceuticals then in many cases use more toxic drugs to treat the side-effects from the initial drugs! Lol. And doctors think they're doing a worthwhile service? Easy money to sit there and throw toxic drugs at patients and hope for the best. The medical cartel is a joke!!!

Oh Jesus Fuckin' Christ. I am telling this soul to avoid surgery at all costs, because of potential iatrogenic complications. I am in total agreement that medical intervention is overutilized and inappropriately utilized in many cases, of which I see complications at worst or no improvement at all. I live this everyday. And I have no holier than thou attitude, just telling it like it is.

Another thing is I prescribe absolutely 0 therapeutic drugs in my job.

Medical System Destruction wrote:

[quote]RastaMon wrote:

Knock if off with your "holier-than-thou" attitude! And if you're even a real M.D., then you work for a system that is now he *3rd* leading cause of death in the U.S!!! Doctors cause so much iatrogenic damage it's unbelievable - so don't preach about an over litigious society until you can put your own house in order first! And face it, Big Pharma runs the show. Doctors treat only the symptoms of ailments & diseases with pharmaceuticals then in many cases use more toxic drugs to treat the side-effects from the initial drugs! Lol. And doctors think they're doing a worthwhile service? Easy money to sit there and throw toxic drugs at patients and hope for the best. The medical cartel is a joke!!!/

Jeez, I wonder were I have heard or read that type of RANT before? You feel better now? Go ahead, take a deep breath, that's it, good boy!

☝️ ? 0/10 ?

RastaMon wrote:

Another thing is I prescribe absolutely 0 therapeutic drugs in my job.

I doubt you're even an M.D. Radiologists are licensed M.D.s Real M.D.s don't provide medical advice to annymous posters on discussion forum - that's a big liabilty no-no. And anybody can say anything about themselves on an anonymous discussion forum...no surprises there.