Rolled ankle injury ;)

Discussion in 'Health Tips for the Martial Artist' started by _Simon_, Sep 25, 2018.

  1. gpseymour

    gpseymour MT Moderator Staff Member

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    I learned some time ago that x-ray reading is part art, part science. The detail is very hazy, and it's not uncommon for two experts to read the same x-ray differently.
     
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  2. JR 137

    JR 137 Senior Master

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    CT scan is far more sophisticated. The picture looks like a 3D model of the structure. It’s the best view you can get without opening it up surgically.

    I’ve never heard of ultrasound being used for imaging this way.

    As far as crutches are concerned, walking boot instead IMO. There’s very, very few instances where crutches are preferred; this doesn’t seem like one. I could be wrong though.
     
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  3. JR 137

    JR 137 Senior Master

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    MRI is as well. It’s better than X-Ray but I’ve seen several surgeons disagree with the physician who writes the MRI reports. It really depends on the specific injury. Some are clear cut, others aren’t.
     
  4. gpseymour

    gpseymour MT Moderator Staff Member

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    When I had the MRI on my arm, they gave me the images on DVD. It was really fascinating to look at. Nothing in there looked a bit like a torn muscle, to me. A few things looked vaguely like bones, but that's about all I could figure out.
     
  5. JR 137

    JR 137 Senior Master

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    Yeah, it’s not like looking at a nice colorful anatomy textbook. And when you look at an MRI, it’s like looking at the anatomy if you were to cut it on a meat slicer. You just have to know what angle you’re looking from and how deep you are. I got pretty good at looking at them, but it takes a while. You need someone to point things out when you first start seeing them. After you’ve seen a bunch of them with someone pointing out what to look for and know what to look for yourself it becomes relatively easy.

    They’re a lot like ultrasound pictures in that way. You see a bunch of gray areas, then someone says “there’s the baby’s eyes, nose, mouth” etc. then you wonder how you didn’t see it all along. If you don’t know what you’re looking for specifically, you won’t see it.

    Looking at musculature is tough. I’ve always looked at joints and looked for things like ligaments, cartilage, bones, etc.

    If you’ve still got it, look for swelling, as that’ll be present wherever there’s an injury. Swelling will show up as brightish white spots. Then again it could be difficult to differentiate it from fat which is basically the same color. I could explain the difference, but I’d have to point it out which isn’t going to work here. And not being an expert, I could mess it up too.
     
    Last edited: Nov 29, 2018
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  6. _Simon_

    _Simon_ Master of Arts

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    Ah that's good about the surgery, doesn't seem like a massive procedure.

    I've only been assisting in the kid's class in my old dojo. It's a highlight of my week, but it might be a bit tricky to help with this, just as we all stand at the front and do all the techniques along with them, and we then go around and help anyone that needs help. Will see though...

    Yeah crutches make sense, but will wait until the CT results come in. This morning at the CT he said about 1-2 weeks or so.. I'll keep it strapped for now.

    Ah right hehe, it would be a tricky picture to interpret I'd imagine!
     
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  7. _Simon_

    _Simon_ Master of Arts

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    Yeah I didn't actually think they did ultrasounds for the ankle area just how awkward it is there, but I could see alot pretty clearly on the screen. It's a boy by the way! XD

    Yeah the boot makes sense. Will wait to see results if I need to keep the area really immobile. I don't mind crutches though, I found them quite fun when I had them many years ago hehe.
     
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  8. _Simon_

    _Simon_ Master of Arts

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    Mmmm..... had a call saying the results were already in from the CT scan, that was fast! But the plot thickens...

    So yeh CT scan also showed a small avulsion fracture at the top of the foot in between two other bits and bone fragment :s. So basically... have to get a cast put on asap. Then physiotherapy after a little while with that on. What an interesting turn of events...

    I also asked her if it would need a surgical procedure to remove the bone fragment but she wouldn't think it would be needed.

    I'm currently not working anyway so that's not an issue, but was currently looking for work haha, may have to find a very very stationary job if it exists haha, any suggestions? Toll booth operator? A very specific type of street performer? XD

    And... was the gold medal at the tournament and everything that it symbolized and meant to me worth all this?

    ........... abso-freakin-lutely :)

    (I really needed some perspective right now, so I'm feeling at peace with alot of it)

    That being said, I'm going to go do chinups and dips now. This time'll also give me a chance to work on my left leg pistol squats ;D

    Ah here was the ct result paper[​IMG]
     
  9. Yokozuna514

    Yokozuna514 Purple Belt

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    Osu, good news bad news scenario but glad you had it checked out. Now you know the answer. R&R is the best route to a speedy recovery. Good luck and keep us posted on the job search ;) .
     
  10. gpseymour

    gpseymour MT Moderator Staff Member

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    Not the best news, but no surgery. Keep that good attitude and figure out what you can work on while you recover.
     
  11. _Simon_

    _Simon_ Master of Arts

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    Yeah for sure it was good that I had it checked out.. thanks ;D. Today am actually going to watch/support a senior grading at my old Kyokushin club (two people going for nidan, two for shodan), just to fuel my inspiration for persevering in this time :).
    Yeah I will for sure, well I'll try my best. Thank you. I can still do hand techniques right? Hehe
     
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  12. _Simon_

    _Simon_ Master of Arts

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    So, yet another twist (feeling like a dramatic soap opera now!)...

    I'll skippity skip through. Have been waiting around for the hospital to contact me. Didn't hear back so went back to docs, she put through urgent referral. Got a letter to make appointment, I called, soonest appointment was 4 weeks, which was too long a wait.

    Went to emergency as the doc said I need a cast on, and if I couldn't get in soon to just go to emergency. Did that tonight.

    VERY busy in emergency... after a 4 hour wait, I chatted with the doc. He went to discuss with some orthopedic doctors, and he basically told me that I won't need a cast at all.

    !

    He said perhaps when I first got the injury I may have, but at this point he thinks it's definitely healed, and that I should be using it as much as possible. Working on range of motion and that I should do physio. Further to that, he called back later and the orthopedic docs he spoke to (after looking at my CT scan results again) weren't even convinced that I HAD a fracture.

    ...

    Needless to say... we were at first quite disenchanted... and p***ed off.. The initial doctor really said that I'd definitely need a cast, and that I did indeed have a fracture, yet this doctor was saying that's not the case and that I should have been working on rehabbing it.

    After asking why my pain had been getting worse, the doc at the hospital even said that it would have made the pain worse by not using the foot at all, that keeping off it was making it worse.

    So even though we were quite angry as I could have been rehabbing it months ago probably, I feel relieved. It means I can start moving again, get back into working, and also start training properly again, which is awesome. It's just been an incredibly challenging and painful few months.. and I had already mentally prepared myself that I would have another 6 weeks or so of being at home, and further to that not being able to drive.

    So will call a physio tomorrow and go from there. Isn't the first time there's been a miscommunication or misinformation, but everyone is only going off what they know and doing their best, so will try to move forward and slowly ease into rehabbing.

    *exhausted*
     
  13. gpseymour

    gpseymour MT Moderator Staff Member

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    I don't remember - was the other doc an orthoped? You've got vastly conflicting opinions on this, and I tend to go with the opinion of the specialist.
     
  14. _Simon_

    _Simon_ Master of Arts

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    My original doc who I saw about this (and who got me to get scans etc) was a GP, not a specialist. So I'm trusting the hospital specialists at this stage.
     
  15. gpseymour

    gpseymour MT Moderator Staff Member

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    That would be my default.
     
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  16. JR 137

    JR 137 Senior Master

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    Yeah. GPs are jack of all trade, master of none for the most part. Runny nose, cough, etc., go see the GP and take their advice. Other stuff, see the specialist and take their advice.

    It’s like a chef at the diner. Sure, he may be able to cook anything, but he doesn’t know and do steak like the guy at a steakhouse.
     
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  17. Dirty Dog

    Dirty Dog MT Senior Moderator Staff Member

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    Did the GP refer you to an orthopod?

    The GP was no doubt making recommendations based off the radiologists report from the CT. And having read a few of them, I can assure you that they're often equivocal. There's lots of "possible this" and "could be that" and "maybe any of these 5 things" in them. One of my favorites is when they say things like "recommend clinical correlation", like "Really? We should look at the patient? Holy crap, what an idea! That never occured to us!"

    My all time favorite was a trauma patient. Guy was a crack head, drunk, hit someone head on. Report came back saying "patient has a structure in the pelvis that resembles a uterus. Question transgender surgery vs true hermaphrodism." We went with retroperitoneal hematoma instead, and sent him to the OR.

    The rule of thumb is to assume the worst and go from that. In your case, that would mean that if the radiologist said you might have an avulsion fracture (which, as I recall, is what I said when you first talked about this injury) they would assume that you DO have one, and should then refer you to ortho. An orthopedist might well look at the scan and say "nope, it's not an avulsion" and take a different route. But that's why we have specialists.

    Many of are convinced that the Coat of Arms for the College of Radiologists is emblazoned "A weasel, eating a waffle, in a hedge, with a bag of money."
     
  18. _Simon_

    _Simon_ Master of Arts

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    Yeah that's what the GP put in for the urgent referral, to see the ortho guys and definitely get a cast on. But at the hospital they were saying that I really needed to start moving it and walking on it, as it's definitely healed (which I'm a little sketchy about.. they looked at the CT which was taken a month ago, but they'd only know if it has healed for sure from another CT taken right now...). But he was saying with a fair confidence that I need to be using it much more, and I felt I could trust that, so I'm gonna get some physio over the next weeks. I've been trying to move it today and put little amounts of weight on it as I walk (still with crutches).

    And haha wow.. yeah I can imagine. When I was at emergency a year and a bit ago (on 5 different occasions due to the severity of the pain), they went through the whole gamut of "it's this it's that". But that's the thing they've gotta consider all options (which they actually didn't get it right anyway in the end).

    Am wondering whether it's worth still keeping the ortho appointment for 4 weeks time anyway... Might keep it and if I'm better by then just cancel it closer to the date.
     
  19. JowGaWolf

    JowGaWolf Grandmaster

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    I have never had a doctor tell me this. Staying off the foot makes the pain worse? So what about the pain you were feeling when you were walking around on it, and it got bad enough to go see the doctor?

    Sometimes I wonder about doctors. I went to one because of really bad back pains. I literally had trouble walking and the pain would bring me to my knees. The doctor was a specialist and he told me that I had a degenerative spine disease and that's what was causing my pain. He said I would need surgery in order to provide relief. One night my back got so bad that I slept on the floor and woke up feeling better, so I bought a new mattress and the back pain went away. Turns out my mattress was the cause of the pain.

    Sometimes I think doctors get into their little boxes so much that it doesn't occur to them that something else may be going on other than what's in their specialty knowledge
     
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  20. Dirty Dog

    Dirty Dog MT Senior Moderator Staff Member

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    You don't really need a repeat CT. How long it takes to heal isn't really all that variable. Especially if they're saying it wasn't really a fracture to being with.

    If it's still not back to baseline, you should keep it.
     

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