What do I do about ankle pain?

[hopefulmummytobe78]

Two and a half months ago I started to experience a sharp pain in my Achilles tendon. I went to see a doctor after a month, and was told I had tendinitis and to self refer for physio.

I saw a physio who diagnoses tendinopathy and prescribed me three calf exercises. I was also told to keep going as normal, to keep going to the gym to walk a lot and to wear heels to take the pressure off my ankle. I did these exercises for about two weeks and nothing was getting better, so I went to a private physio.

The private physio has turned around and said the NHS was wrong, it's weakened ligaments and prescribed a lot of exercises. Five days on and I'm still in pain, codeine, paracetamol and ibuprofen (all taken at different times, obviously) don't touch it.

I can hardly walk, and I was told to leave it at least a month before going back, at which point I'll likely be told to book an MRI scan and surgery may be the only option (surgery for what?? I wasn't told).

I'm in agony, it's affecting my mental health, my ability to do anything besides sleep. I've used ice and heat, nothing helps.

Where do I turn from here? I don't want to poo poo the physio I saw, but it's been nearly nine weeks of pain. I'm not getting any better. It's getting worse and worse and I'm starting to get nervous. Do I go to my GP and ask for a referral for a scan? Will I get a scan or will I be told that, because I've not followed an NHS physio programme for long enough? I feel completely lost, I'm fed up of being in pain and not being able to live my life. I've gone from an active lifestyle (gym 4-5 times a week, long walks at the weekend) to being totally sedentary. I'm at the end of my tether and I don't know what to do

Have you tried ibuprofen or diclofenac gel directly on to it?

In this weather, I'd be worried that the cold was making it worse, so I'd keep thick warm socks on night and day.

I'd also be keeping it raised as much as possible.

I don't know how to get better help from doctors. I wish I did.

I bought some ibuprofen gel today to try.

Hot and cold doesn't make a difference, even after the hottest bath or an ice pack for 20 minutes, the second I'm up and walking it's agony again

Are you in pain because of the exercises the private physio has given you? If you, you need to go and be reassessed.
To be honest, neither physio sounds that good if you've left the appointment without a clear understanding of their assessment and a decent plan in place. It's fine for neither physio to know exactly what's wrong after 1 appointment, getting a diagnosis can sometimes be a bit of trial error, but I would expect a follow up appointment to evaluate the effect of the prescribed exercises and have them adjusted accordingly

I have no clue.

The pain is constant (while walking, and then when sitting down I'm in a lot of discomfort), and doing the exercises definitely doesn't make it feel better. I can't really do the exercises without feeling pain either.

I've done a lot of googling about weakened ligaments and it all makes sense to me combined with my symptoms in the last nine weeks, plus the fact I had 4 severe sprains in about as many months when I was younger. But I just don't know where to turn now

Can I ask what exercises they've got you doing?
Weakened ligaments isn't really a diagnosis. It might be a contributing factor to the problem you are having, but that alone is unlikely to be the source of the pain.

So the NHS physio prescribed seated calf raises, standing calf raises and then hanging over the edge of a step and bouncing up and down on my tiptoes.

Private physio told me not to do that as I was at risk of rupturing something.

He's prescribed me;

AROM Ankle Dorsiflexion
Isometric Ankle Dorsiflexion
Isometric Ankle Plantarflexion
Gastrocnemius stretch in standing
Soleus stretching
Simple single leg stand

And then, when I feel more able (which is not yet, I was advised to wait 2 weeks)

Ankle Dorsiflexion with ankle band
Resisted ankle plantarflexion
Resisted ankle inversion in sitting
Resisted ankle eversion

The private physio has said he thinks repeated sprains with no physio (I was never offered it on the NHS!) has weakened the ligaments and therefore my achilles is picking up the slack and is inflamed and angry. I can definitely feel that my left ankle is weaker and less stable than my right. DR Google (I know! But I can't actually get a proper examination and test) seems to say that this is very much possible, and the only proper solution is taking the strain off the ankle, and surgery.

I feel lost :(

I should add - doing some of these is agony. The stretching and single leg stand are almost impossible. The most relief I get is just after a hot bath or icing it, I get probably a minute or two pain free. Then the pain returns. I just feel totally unable to do anything, because I know I will pay for it the day after

Bumping because I've just done my physio and I'm sat here in agony 😓

@hopefulmummytobe78 Sorry - my sleep thief took ages to nod off.

So the description of your appointment above sounds quite comprehensive, and a reasonable diagnosis/understanding of what's going on.

Sometimes stretching can worsen tendon problems, so that might explain some of the increased pain you experience during and after.

If you can afford it, I'd go back to see the same physio you saw who gave you those exercises. Your response to the exercises they've given you may change their plan, and I do think a month is too long to wait if what you're doing has worsened your symptoms.

Tendon rehab can be a long, frustrating and boring process. The most important starting point is finding some exercises that don't aggravate your symptoms but still strengthen it. It can be trial and error, so don't get discouraged but it does need some regular sessions to get it right.

It's also worthwhile doing some exercise to strengthen up your foot muscles to support the ligaments and balance exercises will also help and shouldn't flare up the tendon pain.

If you're still not happy with the progress I'd ask your GP to refer you to your local MSK service - there you'll be seen by a specialist physio/Dr/consultant who can clarify the diagnosis and advise on further treatment

I find physios useless. An osteopath is normally better for this kind of thing.

What age are you, OP? I am asking as I've experienced pain in my heals/Achilles and, when I googled, found out that it could happen during menopause. Chinese even have special term for this.
I was in agony for about 3 months. It's a searing, burning, excruciating pain. I did not exercise or even walked far all this time. Wore slippers with v thick soles and hoped for the best.

Sorry everyone, hectic shift!

I'm in my 20s. Not menopausal and it's constant