Lump after sprained ankle

[yuvi14]

5 Months ago I sprained my ankle, but I still have pain. I think most of the damage has healed up, but I still have a hard lump on the top of my foot, that looks like a small "hill" under the skin. It doesn't feel like the swelling up which you get right after the ankle sprain happens, which is soft when you touch it. My lump is quite hard, and only hurts after I exercise or put force on it (for instance: put pressure on it with my fingers or something). It also becomes red in the area when it hurts.
Every website tells you what to do to reduce swelling, but it's only relevant for immediately after the ankle sprain happens. What can I do to remove the lump on my foot? Is there some kind of massage, laser, heat/cold treatment or something? I don't know I'm just throwing ideas.
It's not just the fact that the lump is ugly that worries me (because it makes my foot look deformed when you look at it from the side), I think that my foot hurts the most in that area. So to stop the pain I have to get rid of the lump.
Does anyone know what to do? Just throw me some ideas, even tell me if you know what the lump is at least and why it's there.
Thanks

[thomas bibu]

hi dear,

well, a couple of weeks back I had a patient with the similar problem. he had injured his left ankle while playing rugby, was treated conservatively with tetra ankle immobilizer and was on NWB crutch walking for 6 weeks.

following the 6 week period, he did undergo physiotherapy elsewhere for his post-traumatic stiffness. his ankle regained full range of motion and he was able to carry out his ADL without any problems.

he visited me, precisely 3 months after the injury, since he relocated here with complaints of a dull ache following exercise and palpable firm lump over his anterolateral aspect of the left ankle. I discussed with him the possibility of scar-tissue formation and treated him with continuous ultrasound & figure of 8 ankle bandaging while playing/exercise.

I did follow-up once weekly over a 3 week period to check whether the lump increased in size keeping in mind to rule out possibility of; bony exostosis, cyst, or a benign tumor. the lump size remained the same, but the patient did not complain of any pain or dull ache even after long walks, strenuous exercises etc.

I have not examined you, but from your description it looks like the same pathophysiology. well, try to undergo at least 3-5 sessions of physiotherapy and see how it goes. If it tends to remain the same or gets worse consider further tissue studies. If everything within normal limits you may try a steroid shot and if pathological surgical intervention.

keep me posted. all the best.

cheers,

thomas

[yuvi14]

Hi! First of all I want to thank you for taking your time to help me. I connot find a doctor who understands my problem in my home country, Israel, so it's good to know that there is someone oversees who is happy to help!
I made a list of some words and phrases from your last post to me, that I didn't understand. So that I can understand "the big picture" I must understand these things first, so could you please explain them to me roughly?
-Tetra Ankle Immobalizer
-NWB crutch
-ADL
-Anterolateral aspect of the left ankle (by the way, the ankle I sprained was the left one too)
-Scar tissue formation(I've heard the term before, but I don't know what it is)

I quoted your last post to me (bellow) and I have some questions to ask (other than the words I've written above)

Originally Posted by thomas bibu

hi dear,

well, a couple of weeks back I had a patient with the similar problem. he had injured his left ankle while playing rugby, was treated conservatively with tetra ankle immobilizer and was on NWB crutch walking for 6 weeks.

following the 6 week period, he did undergo physiotherapy elsewhere for his post-traumatic stiffness. his ankle regained full range of motion and he was able to carry out his ADL without any problems.

he visited me, precisely 3 months after the injury, since he relocated here with complaints of a dull ache following exercise and palpable firm lump over his anterolateral aspect of the left ankle. I discussed with him the possibility of scar-tissue formation and treated him with continuous ultrasound & figure of 8 ankle bandaging while playing/exercise.
What does ultrasound do for this injury? How can the bandaging help(does it just stop the foot from swelling up or can the prussure or something bring down the hard lump?)

I did follow-up once weekly over a 3 week period to check whether the lump increased in size keeping in mind to rule out possibility of; bony exostosis, cyst, or a benign tumor.
Why did you rule out these possibilities? Are these things that are often caused by ankle sprains?(I don't know what any of them mean)
the lump size remained the same, but the patient did not complain of any pain or dull ache even after long walks, strenuous exercises etc.

I have not examined you, but from your description it looks like the same pathophysiology. well, try to undergo at least 3-5 sessions of physiotherapy and see how it goes. If it tends to remain the same or gets worse consider further tissue studies.
What do you mean by 'further tissue studies'? Where can I have this done?
If everything within normal limits
You mean if the tissue studies show that nothing is wrong?you may try a steroid shot and if pathological surgical intervention.Okay, this is the first time I've heard of those things aswell.

keep me posted. all the best.

cheers,

thomas

Thanks a lot, I have a feeling that you know the right way to treat my condition, unlike my physiotherapist who only wants to let time do its part!
Cheers to you too!
Yuval

[thomas bibu]

hi yuval,

with respect to your query let me answer the following;
1. tetra ankle immobilizer - its just an ankle immobilizer, tetra is the brand name. I use this product because it is approved by FLARE - Foundation for Latex Allergy Research and Education.
2. NWB crutch walking - well, NWB stands for Non Weight Bearing.
3. ADL - stands for Activities of Daily Living.
4. Anterolateral aspect - anterior means front, lateral means outer side.
5. Scar tissue formation - well, scar tissue or fibrous tissue formation is a normal biologic process of wound repair/healing in the skin and other tissues of the human body. Though it is a normal or natural part of the healing process, in some patients the extend tends to be prolific.
6. Ultrasound therapy is an accepted treatment modality for the management of prolific scar tissue formation.

hope you are clear now. take care,

thomas

[IceMan]

I would recommend finding a therapist who is skilled in Mulligan joint mobilization techniques. In my experience as a physio I've had great success when treating both acute and chronic ankle sprains with posterior glides of the distal tib-fib joint at the lateral malleolus (in layman's terms gently pushing the bone on the outside of the ankle posteriorly).

Mulligan suggests that when you sprain the outside of the ankle (lateral inversion sprain) the fibula moves forward in relation to the tibia at the ankle joint. From what I've heard (I'm by no means a Mulligan expert) Mulligan theorizes that the swelling that occurs when you sprain the ankle in this way is primarily due to this bone being "subluxed" anteriorly.

Once I've mobilized the joint in this way and having regained some degree of ankle dorsiflexion (the movement of your ankle when the top of the foot moves towards your head) I usually tape the ankle in a similar way to the Mulligan technique, which can be seen on video here (Mulligan Taping Techniques - Inversion Ankle Sprain). I then follow this with exercises - range of motion, strengthening and so on.

[mr_c]

i went ova on my ankle about a year and somthing bk, being stupid i left it thinking it'll be fine. . . I left it and it healed sorta leaving a lump, so i went to the doctors he had a look and said it was fine and gave me some excercises,
i started boxing again and did a lot of skipping, but now its acheing on the out side about 3inches up from where the injury was, is this normal or should i rest it???

[jacinta]

Hello IceMan,

I had a pt who's a national level football player.
His symptom of lat ankle pain inferior to Lt. lat. malleolus persisted
after the arthroscopic surgery 1/12 ago.
a week ago, i applied the Mulligan's tapping technique to him , combining other MWM,
& it solved his problem (mine as well).

Thanks for posting the video.
Cheers~!

[IceMan]

Excellent jacinta! I'm glad that it worked for you. Thanks for letting me know that it helped.