Previous fracture, new pain

[Ariemai6]

Hey everyone.

I’m hoping someone can help me out here, maybe based on their own experiences. I would be very thankful as I feel quite at a loss about what to do.

I haven’t been diagnosed with RA but I’m having such pain in my ankle joint which I broke many years ago and having no answers through X-ray I paid for a private MRI. It showed tiny dorsal Talonavicular bone spurs, bone oedema, bone bruising and cystic change to a ligament, (I can provide the actual report findings if helpful). I’m also flat footed so that doesn’t help I guess, ...have had fibula fractures on both feet at separate times and had to wear casts.

I feel like I’m not getting anywhere with resolving the pain and inflammation in my ankle and it’s affecting my work and my mood. I have been referred to ICAT’s, a multi disciplinary team of Ortho doctors/ Physio/ Podiatry. Yet the referral takes six months and in the mean time my ankle feels so unstable like it’s ready to break again. Also my GP will not consider giving me a steroid injection until I have seen the ICATs team which means the inflammation can’t be eased whilst I’m waiting.

Really considering paying for a private consultation with an expert, either a foot and ankle surgeon or a rheumatologist, not sure which is more appropriate? As even though money is tight I fear waiting for intervention is risking making my ankle worse and I really would rather avoid taking time off work.

Any advice would be greatly appreciated, as I’m starting to feel pain is just the new norm now.

[hawker955]

If you have fractured a joint then it can often lead to osteo-arthritis, i.e. wear and tear, due to damaging the joint surface and also the abnormal wear and tear as a result of that. Nothing to do with RA but just a consequence of incorrect" pressure distribution within a joint after the damage. I think that an orthopaedic consultant, surgeon or otherwise is he person to see. Joints are naturally smooth for a good reason. = Spreading the load and pressure evenly.

HTH?

[helixhelix]

It seems by referring you to ICAT your GP thinks that it is a problem centred on your foot rather than an underlying inflammatory disease? So thinks it's more likely osteoarthritic changes? In which case rheumatology will have few (if any) solutions to offer you except referring on probably to the same unit you are already referred to....so could be a waste of your money. You could ask GP if he/she would also refer you to rheumatology just to see what the response is as that will give you an idea of whether it's worth seeking a private appointment.

And before you head off to a surgeon, have you tried all the possible things you could do yourself? So footwear is important, have you tried different types to see if they help take pressure off critical points - like rocker bottomed shoes. Or different types of insoles. And are you the right weight?

Also think through what you want from a consultation with an orthopaedic surgeon. Surgeons tend to come up with surgical solutions, so would you be ready for that?

I wonder whether a specialised foot podiatrist would be a better first step - basically the private version of the ICAT you've been referred to. So rather than looking for a single orthopaedic surgeon, look for private clinics that specialise in feet so are multi disciplinary.

[Ariemai6 in reply to helixhelix]

Hi helixhelix, thanks for your reply. Some really good info there. I’m ten stone at five foot three so I could stand to lose a bit of weight to take some pressure off my joints. I do have hypothyroidism, diagnosed at 17 (27 now) but suffering for long time before that.

I actually have been wearing orthotics (custom made) for some time now but not as strictly as I should be I suppose. I also have a very active job in healthcare where I’m on my feet for 13 hour shifts and I know that will have to change as I’m not cut out for that kind of work feet wise. My first thought was indeed to see a podiatrist but having had orthotics I couldn’t see what I might benefit from more orthotics but perhaps they will have a different approach this time. I guess rheumatology came to mind because of the inflammation factor.

I’m open to surgical options though if I thought they would be effective at fixing my ole flipper feet for good ha.

[oldtimer]

I would probably pay for an opinion from a qualified podiatrist first - they have specialised training in that area and may be able to help with an orthosis which would reduce your pain and possibly postpone any other intervention for a time. Surgeons tend to look for surgical solutions, but the podiatrist would also be able to advise you on whether a surgical solution is needed.

[Ariemai6 in reply to oldtimer]

Thank you oldtimer, I guess I thought podiatry might only not be able to advise me on the scope of the changes within my bone like an Orthopaedic surgeon specialising in foot and ankle conditions might. In a way if I was told I had to have surgery I would be glad as long as I thought it would be a long term solution rather than a quick fix.