Sprained Ankle/Foot pain real Injury or TMS?

Hi Guys,

I posted in ask a TMS Therapist but thought this would also be a good place to see what people think.

Back in January 2018 about middle of the month, I was going through a bunch of shoes trying them on because I needed a pair to wear for a convention that goes on that I work at for 4 days on my feet. My job normally is in an office but we do the convention once a year and I've been at my job for 12 years now. I know on one level I really don't want to be at the convention as it is very social and I have to carpool there and work at the booth the whole time.

So, I was putting on different shoes and couldn't find a comfortable pair and this made me angry at myself on why my feet don't just fit. I felt I was running out of time and needed something soon. I was in a mall and on my way out my right foot felt like it got twisted or bent over too far. I felt some pain and thought uh oh...did I just hurt myself? It didn't feel right after that so after a few days I went to urgent care and had it looked at. My foot was not blue or dark and the pain was bad but it wasn't on the surface so when the doctor felt it, he thought it was a very minor sprained ankle. I was nervous on standing on my foot in a week for 4 days so I ended up telling work and they got a chair that I could sit on for the convention. My foot seemed to be hurting really bad whether I was sitting in a chair at work or standing, or even laying in bed. I ended up getting a brace at big 5 sporting goods to help it. I started to cry after work on my way to get a brace as I didn't want to make a scene at work on the discomfort and the stress of what if it doesn't get better?

Some of the pain could be described as burning or a pin needle feeling, sometimes feels like something being pulled or stretched...It is the very bottom right side like the nerves and it can go upward in the back towards the ankle/back of the foot. Sometimes standing causes issues or walking, sometimes it hurts in general, other times just sitting down in a chair and my foot will be irritated.

I got a brace the first week it happend and I felt some relief. The week later, I had to drive to the convention, there was traffic and I was stuck driving for 2-3 hours. The pain was really bad from the stop and go motion. When I'm walking it wasn't as bad but in that position of the pedal, it irritated worse.

Long story short, I felt stressed out and ended up leaving home as I thought I may have had food poisoning as my stomach was all knoted up and I couldn't talk one of the nights after hours during dinner with the group. After I came home, it slowly went away and I felt normal again so I think that was just stress of the whole thing. I felt dissapointed in myself realizing it was anxiety at play and I couldn't just make it through the show the 2 days left of the 4.

Long story short, it is now June 20th, I saw a podiatrist foot doctor a few times and tried a sock like brace thing he gave me which gives support and helps tendonitis/sprained ankle, he thought I may have had tendonitis or ligament issues as I explained when I initially hurt myself. Since I felt like I wasn't feeling better, I ended up getting an MRI of my right foot and this is what it says.

I haven't gone back to see him yet because I'm not sure what he would suggest next and am wondering if there is any reason for the pain or if this all points to TMS and may be counterproductive to continue the Podiatrist route.

MRI Findings:

Tendons: There is no evidence of tendoinosis, tendon strain, tendon tear or tenosynovitis. The peroneals, flexors, extensors, and achilles tendons are well visualized.

Osseous structures. No evidence for osseous stress response, fracutre, or avascular necrosis. No evidence for talar dome osteochondral defect. There is no evidence for coalition.

Ligaments. The syndesmotic ligaments are intact. The anterior talofibular ligament midly tented, but noting intact fibers. The calcaneofibular and posterior talofibular ligaments are intact.

Plantar fascia is not thickened or torn. There is no plantar denervation effect.

other findings. The fat planes in the sinus tarsi are preserved. The onctents of the trasal tunnel are maintained.

IMPRESSION:

1. No acute tendon injury. The peroneal tendons are intact.
2. Midly attenuated anterior talofibular ligament with otherwise intact fibers. No acute changes seen.
3. No acute fracture, ostenecrosis or stress response.

From this, it sounds like there is some attenuation on my ligament in the back right where I do get some pain but my question is is this normal or from the actual injury? Is the injury more of a mental reason to cause distraction for me or does it just require actual time to heal?

Right now, I have been wearing a sock shaped thing (perhaps still called a brace)? with a figure eight strap around it that I put on in the morning and keep on until I go to bed.

My mind tends to go all over the place not sure of anything so I wonder if the sock brace thing is good to wear or if perhaps I shouldn't wear it at all and maybe it is all psychological. It has been 5 months now.

I have had TMS related issues in the past with my hands with tendonitis in my forarms and hand pain. I also had shoulder pain from an actual injury that started hurting for awhile and I was able to calm that down after getting an MRI and realizing it was so minor.

For some reason though, my foot it scares me as I like to take hikes and also my convention thing will be coming up again in January so I just think, I will need to be on my feet this time (no chair) and I start to have fear of will it be healed by then. There is just an insecurity. I don't know what to believe as TMS is not really widely believed so it gets confusing seeing a foot doctor.

Looking at the MRI report, I would really appreciate thoughts on this. It could certainly be TMS again but what if it isn't? Should I not wear the brace anymore?

Thank you very much for any help on this!

 

Can't seem to find a way to edit this but it should say "Mildly" instead of "Midly" (spelling mistake) on the ones that are in bold. Anybody have an opinion on this? It would really be helpful.

This gets confusing in my mind as if it is TMS, doing a brace or wearing a neo sleeve kind of thing is probably counter productive as it reinforces a physical injury and not TMS.

Should I go back to see my podiatrist as he looks at the MRI report or is there enough evidence to say this is definitely pychological based on what I've said and looking at the MRI report I provided? On the other hand, is a sprained ankle still valid after 5 months? Should I continue on the path of treating this as a physical thing?

 

Keys,

I think you have plenty of evidence this is TMS. Both physical findings as well as the emotional. You have stress and conflict about the convention and fear about a bad injury.

I've had a severe sprain that took two months of physical therapy and was soooo painful. Then I was fine. After a couple months you should feel better. Even if you lost mobility because it was bad (which yours wasn't, even though very painful) you should have no pain, as there is nothing in your ankle to cause it. About 4 weeks ago I had a minor twist going down some stairs and I could see right away how my Tmsy system might latch onto it. It was weak for a few days and then was back to normal. Now 4 weeks later I can stretch the ankle and feel.....hmm...slight tenderness? up my calf and down my foot. That's normal. I was able to keep calm and not apprehensive about it. When you look back at your post can you see how apprehensive you feel?

I would start exercising you ankle to regain strength you have probably lost from rest, and work on TMS protocols, maybe do Alan Gordon's program here focusing on the emotions around the ankle. Maybe it'll tell you something about yourself.

I hope you are feeling better about all this soon!!!

Lizzy

 

Lizzy has the right idea, I agree. Your MRI was normal- no sprain, strain or even tendonitis (which is TMS in chronic form anyhow). You can rest assured your pain is from TMS...any TMS doctor would tell you this. "Attenuation" is just referring to the MRI signal being weird in one ligament, no biggie, nothing to worry about. I would work on your TMS methods for sure!

 

Thank you, Lizzy and MindBodyPT! It really helps to not feel so alone in all this.

Lizzy, I do definitely have fear or apprehension on these kind of things. I'm a creative person and can be quite emotional/sensitive although I don't show it very often to people. I think this creativity can start to affect my thinking and results in anxiety as I can start to focus on "what if" especially if it isn't getting better. I can get obsessive about it and start to fear and when it starts to feel worse, then more apprehension occurs. I seem to struggle with anxiety in general and try to keep it under control and do well for the most part. It is definitely helpful to get some reassurance this is not something I should fear so much.

Do you think your physical therapy actually did help and something I should bother with? From what I understand, treating the condition as physical can be counterproductive as Sarno says he tells patients not to do Physical Therapy and not to treat it as a structural issue. I guess I get confused on if TMS is only possible when there was never an injury in the first place or if an injury can happen and then TMS replaces the real injury with continual pain as more of a neural pathway for the brain to use?

If I should do some exercises for the ankle, an you recommend Liz?

Question for you MindBodyPT, looking online at the word Attenuation, it looks like it means to taper (not as thick) or thin out so doesn't that mean my anterior talofibular ligament is actually weak although fibers are intact instead of the MRI signal itself being weird as you say? That is the area where I felt soreness and pain so that is why I'm putting some more focus on that part even though it does say "mild" attenuation. I'm just curious if this indicates evidence that an injury at some degree occurred?

Do you guys suggest the Neo-Sleeve is probably better not to wear? Do you think it is better to not see the Podatrist at this point as it probably will be focused structurally? I took the MRI but didn't see him afterwards to talk about it.

Thank you both for responding back! It helps a lot.

 

Please don't put stock in your MRI. We all have "abnormal" findings! Many of us on here who have healed with TMS methods had "abnormal" MRI results, myself included. I herniated 2 discs probably many years ago but of course they still show up, and i'm fully healed from my TMS pain. Throw the MRI away if you have to! It is honestly irrelevant even if you ever mildly strained it at one time. TMS can occur when "piggybacking" onto a real injury (remember, injuries heal within a matter of weeks to months, especially strains). TMS can also occur where there never was an injury, both are equally likely. It honestly does not matter at this chronic stage...whether there was a strain or not, you would have healed at this distance. Your pain is from neural pathways in your brain. You must grasp this concept and realize that you have excellent evidence that your ankle is normal.

Yes the podiatrist will focus structurally, so do with that what you will. Go in knowing what you'll hear, consider consulting a TMS doc instead if it will help you feel more secure in the diagnosis. When treating TMS pain, it really is best not to treat it physically. As a PT I can tell you that mild strains and sprains heal perfectly well without PT anyhow, so whether or not you ever had one or not you are ok not to do PT. It's fine to stretch and exercise to feel good and relieve pain temporarily but know that is what you're doing, rather than getting at the real cause of the pain. Wear the sleeve only if you want, but same thing goes- think of it like Tylenol for a fever...temporary relief. Your true healing will come from doing TMS methods.

Hope that helps clear it up, let me know if you have a question!

 

I can add so little to MindbodyPT's answers!!

When I had physical therapy it was right after I injured my ankle, so it was hard work and it helped. You don't need to do that. Whatever exercise you would normally do is perfect. Walk, run, squats or whatever, you just need to use the ankle because it is fine.

Belief is part faith, but also part agreeing. You can work your belief by intellectual agreement with your diagnosis.

Lizzy

 

Thanks Lizzy and MindBodyPT for your thoughts! Really, it helped me push forward the last couple of months. Unfortunately I still am having issues with my foot. I tried to simply ignore it and do things anyways. I thought that might be working but again the pain seems to still be there. I didn't end up going to the Podiatrist as I figured it would just create more focus structurally. I still have fear that by doing things I could be making it worse. It feels that way anyways. For example, I tried to ignore the pain and the what if's on it and walked on the sand, even did a sprint and found that it started hurting later. I did a hike and that caused some pain as well. The foot can start to hurt on the side when I am sitting on a chair or if I put that leg up on the other foot in a cross position a little bit. If I stand it can start to get irritated sometimes too. It can even feel painful doing nothing which makes you think it got hurt from standing on it before or something.

What is the story on Ankle instability? I recall my podiatrist telling me that I may have that when I had last seen him before the MRI. From what I saw on it online was that Ankle Instability can cause long term chronic pain. Is it possible that the anterior talofibular ligament being attenuated is causing instability/pain or is this not really "possible"? I know that is the area if I push on it or feel is the pain area. Will strengthening exercises help if it is instability? Reading that some people have complications with instability got me afraid again thinking I could be one of these people by "ignoring" the pain.

Do you guys know if people have attenuated ligaments that don't have any pain? Similar to herniated discs on an MRI of people who have never reported back pain? Just trying to find a way to convince my mind that the attenuation doesn't mean anything despite feeling pain in that area. The pain makes me think there is something going on there and I'm trying to convince it that it isn't a real issue but part of my lack of being a doctor makes me unsure what is true (if it is just physical problem or if it doesn't make sense to be physical like the instability thing) except that I am having pain there.

Can a ligament ever be changed from attenuation to normal by strengthening exercises or with time (body healing) or does it just stay that way?

Really appreciate the support.

 

Hi!

It sounds like you're doing a bit better. You don't sound as worried as before.

I'm not an expert, but I can tell you about a friend. She could sit and have her ankles roll so that the soles of her feet touched each other. So, her legs bellow the knees went straight down to the floor and her ankles turned ninety degrees. She was a physical therapist and said some people are like her and could never sprain an ankle because they're so flexible. Sadly, we were talking about it because of my nasty sprain. So, I don't know if an MRI would show something scary on my friend's ankle, but it wouldn't matter because she has no pain. All this stuff is just wear and tear, like a freyed cuff, it is not a cause of pain. Our conflicts, worries, resentments and fears cause our pain. If you still fear your ankle isn't okay, then your neural pathways are still "lit up." I have been using Claire Weekes techniques regarding panic to teach me how to float passed my fears. You might read about this in one of her books, or listen to her on YouTube.

Lizzy