Injuries and Medical Advice: Wrenched Ankle

Q:
About a month ago I fell while climbing and tore ligaments in my left ankle. Could you provide a time frame for how long it will take to heal? The CT scan showed an old Lisfranc fracture though I don’t remember ever having injured it. So I am confused as to whether I have a fracture or torn ligaments.

—Lauren

A:

In the early 1800s, Jacques Lisfranc de St. Martin, a military surgeon in Napoleon’s army, was busy defining the intricacies of amputation. Aside from patenting surgical techniques to remove kidney stones, your rectum or your cervix without causing immediate death— emphasis on “immediate” rather than “death”—St. Martin is best known for minimizing surgical amputation in soldiers with gangrenous toes by cutting the foot across the middle through a cluster of joints that subsequently became known as the Lisfranc joints (now known as the tarsometatarsal joints). This brings me to my point: a “Lisfranc fracture” tells me very little about the severity of your injury other than that you have broken at least one bone broadly in the middle of your foot (at some point in the recent past).

Non-displaced mid-foot fractures are more common in climbers than regular folk due to the translation of impact forces while wearing a tight shoe. Although ligaments are often preserved, it is very much situational. Either way, recovery will be somewhere between four to eight weeks, although severe soft-tissue injury, i.e., a bad sprain, will add many months.

Ultimately it comes down to the clinician’s evaluation, i.e., tenderness, swelling, pain pattern, etc. Given that you have no recollection of a cataclysmic foot injury that could account for an “old Lisfranc fracture,” an MRI may provide more information. Whether an MRI is warranted depends on multiple factors, not least of all whether the findings are likely to change treatment from this point in time. That is, even if the MRI suggests the fracture to be more recent, will it change the regimen? I would go back to your doctor and simply air your concerns.

Should you go see a doctor?

If your ankle has lumps and bumps that are not normally there, you’re probably not fine. Get an X-ray.

If you can’t stand on one foot and move your weight around without collapsing, get an X-ray.

If the skin looks like there is an expansive cyclonic storm cell brewing inside, you guessed it: X-ray.

Ankle is swollen and looks like a football. Bad. X-ray.

If after a week your approach of ignoring the pain and disability is failing abysmally, see the doctor.

Caveat: patterns of swelling and bruising are complicated and fractures may produce surprisingly little or either.

 

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