Are your ankle ligaments loose? I used to have a bad ankle that I twisted running more than 20 years ago. Like many of my patients with ankle problems, mine wasn’t bad enough for surgery, but unlike many of my patients I have long since ditched ankle braces and gotten mine fixed without surgery. If ultrasound stress testing had been around when I injured it, I would never have had to suffer through ten years of being an ankle brace connoisseur!
The ankle joints are stabilized by strong ligaments that can become torn or stretched. For some patients, the ligaments are torn enough that they’re offered surgery. In 2015, in our experience, most of these patients no long require surgery thanks to new precise injections of orthobiologics like stem cells. However, the most frustrating thing for a patient (I know as I was there), is to sprain your ankle and not have huge findings on MRI and then to be told you’re fine by a surgeon when you can’t go back to full activities without ankle pain. Patients in this category experience everything from mild pain with activities to worse-requiring a brace to do any carrying or hiking. While I eventually got my ankle fixed with orthobiologic injections to rebuild the damaged ligaments and ditched my brace collection, had ultrasound ankle stress testing been available in 1993 when I twisted my ankle, I would have short cut about a decade of trying every ankle brace on the market!
What is ultrasound stress testing? Ultrasound is the same technology used to see babies, but tweaked so that it’s good at seeing structures like ligaments. As you can see from the video above, for an ankle, the doctor places the ligaments to be tested under stress, just like during hiking or running. While the ligament looks fine without stress like it would in a static MRI, the ligament can look quite different under a challenge. When an abnormal ligament is placed under these real world forces, it gives way and stretches too much. However, a normal ligament doesn’t give way or stretches only a little.
What does this have to do with why your ankle hurts? Placing weight on it causes the ligament to stretch too much and the joint to move in weird ways. Again, realize that many of these patients who clearly have bad ankle ligaments on a simple ultrasound stress test would also have had negative MRIs. What if your doctor doesn’t know how to do this test? It’s 2015 for God’s sake, find a doctor who does.
The upshot? If you have chronic ankle pain with activity and have to use an ankle brace and either don’t want surgery or nobody thinks your ligaments look too bad on MRI, then you need ultrasound stress testing. The ligaments everyone thinks are fine may be totally stretched out and working poorly. Leaving your ankle like this over years can cause arthritis, so there’s another reason to act. Given all of the great solutions that we now have for helping these ligaments heal through precise imaging guided injection, it’s time to get tested and ditch the brace!