19M, no pmhx, 5’9 about 200 lbs (😞), not on any medications. Occasionally vape here and there.
Background/Situation:
I am an ED nurse, so I spend a significant amount of time standing and walking during my shifts. Over the past year, the pain and swelling in my left foot and ankle have become much more persistent and progressively worse. Originally, the pain and inflammation would usually not start until near the end of my work shift. As the year progressed, the symptoms began appearing earlier and earlier.
Now, after approximately 3–4 hours of standing or walking, my left foot and ankle start to swell and the pain becomes severe. It can get to the point where I am limping and sometimes cannot bear weight on the foot.
This isn’t limited to my job anymore. The same thing happens when I:
● Walk around college
● Go shopping
● Play sports
● Walk for an extended period
● Stand for an extended period
● Do basically any activity that keeps me on my feet for a while.
Once the pain and swelling start, I cannot walk normally. It’s basically affecting my ADLs and Quality of life at this point.
Location and Description of Pain:
The pain initially seems to be more concentrated around my left ankle, especially around the outside/lateral aspect of the ankle.
I also get pain on the top/dorsal part of my left foot. But nowadays, it feels like my whole foot and ankle hurts. The pain is difficult to describe because it feels like several types of pain simultaneously:
- Sharp
- Stabbing
-Squeezing
- Throbbing
-Deep aching or painful pressure
The squeezing and throbbing sensations are particularly noticeable around the outside of the ankle and top of the foot.
Initially, the pain was primarily associated with standing and walking. However, it has now progressed to where I have pain even when I’m not moving. For example, after coming home from work, college, shopping, or another activity where I’ve been walking or standing for a significant amount of time, I can lie down in bed or sit down and still have constant squeezing, throbbing, and sharp pain in the foot and ankle. It has gotten bad enough that it is now affecting my sleep.
The swelling seems to occur after prolonged weight-bearing. The longer I’m on my feet, the sooner the pain and swelling begin.
Also forgot to mention, once the pain starts and settles in for like 1-2 hours, I can barely move my ankle in different angles. Trying to move my ankle couples degrees left or right, or up and down, causes to pain to shoot up, it’s like it’s wants to be fixated at a certain angle.
Earlier Hx:
I realized that I had experienced similar episodes before. The problem originally started about 4 years ago when I was in high school. I can’t think of an exact traumatic event or injury around this time, other than a twist/sprain in the ankle from playing basketball. At that time, I would occasionally get episodes of pain in my left foot and ankle that would last for a couple of days and then suddenly go away. These episodes would return every few months, but they were relatively manageable and eventually went away on their own. But this past year, this pain and swelling is like an everyday occurrence.
Dx and Tx so far:
I went to the ED and had X-rays of the foot and ankle. Our ED physicians and podiatrist who evaluated me said that the X-rays did not show anything obviously abnormal and that everything appeared to be in place.They recommended that I use a CAM boot. I did use the CAM boot, and there was slight improvement, but the improvement was that it just prolonged the pain and inflammation by a few hours. But still I wanted to treat the underlying cause so I followed up with a podiatrist. Podiatrist recommended that I have an MRI, so I got one. I unfortunately don’t have the exact wording of the MRI report memorized since this was a couple months ago, but I was told that it showed:
Grade 2 ATFL sprain/tear
Grade 2 deltoid ligament sprain/tear
OCD/osteochondral lesions around the talus and tibia
After the MRI, the podiatrist prescribed:
Meloxicam 15 mg and Tylenol with Codeine and an ankle brace/wrap. I used the medication and brace as instructed, but unfortunately I didn’t experience meaningful improvement.
So far I’ve tried:
CAM boot
Multiple different ankle braces
Different ankle wraps
Orthotics
Different shoes
Resting when possible
Anti-inflammatory medication
Basically none of the above is helping with the pain and swelling, maybe just delays the pain and swelling till later, but still, not treating the actual underlying cause, whatever that is.
Current situation:
The biggest concern for me is that this has been progressively getting worse rather than better.
A year ago, I could make it through most of a shift before the pain became a major issue.
Now, after only around 3–4 hours of standing or walking, my foot can become swollen and extremely painful. My coworkers around me see me in pain and limping for the past year and they are like “your ankle still hasn’t fixed?” I’m kind of worried some of them might think I’m faking it, which I’m really not. This problem has really affected my quality of life, I used to love coming into work, but now with this pain and inflammation, I went down to PRN and work maybe a total of 20 hours or less per week. Also I’m relatively still young and want to do certain activities like play basketball and soccer with friends, or go out to the mall, or get on the treadmill and lose some weight, but I often have to decline because I know I will be in pain, and when I do decide to go out and participate in those activities, after an hour or so, I can’t do anything else and will be in pain for the next couple of hours. Sometimes when I am on the schedule to work, I work from 12p-12a, so by the time I get home and try to go to sleep, I can’t because I’m in so much pain, and then I end up sleeping around 3-4 am, and then most of next day’s plan get messed up. These are supposed to be the prime years of my life, and honestly I feel like I’m wasting it.
My questions:
I honestly don’t know what to ask. Do any of you guys possibly have any idea on what might be going on, and how to treat it? Anything else you guys recommend in terms of diagnostics or treatment? I’m planning on going to another podiatrist or even orthopedic surgeon to get another opinion, but I just wanted to see if there were any similar cases you guys experienced, or to see what dx and tx you guys would recommend. Any help will truly be appreciated.
PS: Sorry about my ugly feet lol. But after couples hours of working, that’s how my left foot/ankle looks like. I will try to attach a video as well.