Diagnosis

OK, I took a couple hours this afternoon to do some research on my own in an effort to gain a better understanding for myself of what exactly is going on with my ankle.

Following is copied much of a report from San Francisco Advanced Medical Imaging's MRI on my right ankle. I did my own research in order to translate this report from Latin/med terminology to English and I include several links to wiki definitions, images, etc. within the report below.

I summarize all the hoo-ha in Yo English like this...

I have partial tears in 2 tendos and 1 ligament around my right ankle. Paricularly the Peroneal Brevis and Longus tendons and the Anterior Talobibular ligament.

Nother words - my foot and ankle are showing the wear and tear from 25 or more years of footbag freestyle and footbag net, not to mention gymnastics, and lots of other athletic activity such as running and riding my bike around like a crazy person :).

So, what's up with the "partial" in these "tears". Is surgery the best route for me to go? The Dr seems to think so and I'm worried about his bias. To his credit he did not, in any way, leave non-evasive therapy out of my options, clearly said the final decision is mine, and also stated he would not be offended if I sought a second opinion.

He also said there is 'at best' a 50% chance that non-evasive therapy, not surgery, will eliminate symptoms and something less than a 50% change that non-evasive therapy will actually heal the "partial" tears, as apposed to just making them asymptomatic. Furthermore, he said it's likely we wouldn't be able to tell if non-evasive therapy will work unless I want to pay for an MRI myself following therapy. You see, insurance probably wouldn't cover another MRI on my ankle if it was asymptomatic.

Surgery or no surgery? That is the question.

The prognosis is 8 weeks to 100% recovery in either case. Perhaps it's more accurate to say that it's an 8 week process in either case. With non-evasive therapy there is no 'recovery' but possibly some immobilization followed by physical therapy and it may not work.

According to Dr Clark, surgery is a pretty sure thing for immediate success. But what are the long term effects of surgery? Do the benefits of this sure fix outweigh the long term impact of cutting into my ankle and getting all up in there and shit?

Ok - now I really geek out. The report, my links, definitions, etc.

My podiatrist is Joel Clark, M.D.

Best I can tell the radiologist responsible for interpreting my MRI was Sonja Moelleken, M.D.

REFERRING PHSICIAN: JOEL CLARK, M.D.
EXAM: MRI RIGHT ANKLE
CLINICAL DATA: Ankle Pain
MR#: 45492
DATE OF EXAM: 12/07/2007 19:30

Follow the links for definitions, images, etc.

IMPRESSION:

1. PERONEAL BREVIS AND LONGUS TENDINOSIS/PARTIAL LONGITUDINAL TEAR AT LEVEL OF LATERAL MALLEOLUS AND DISTALLY WITH SURROUNDING TENOSYSNOVITIS.
2. POSTERIOR TIBIAL TENOSYNOVITIS WITH OS NAVICULARE, FLEXOR DIGITORUM
   TENOSYNOVITIS IS PRESENT.
3. PARTIAL TEAR, ANTERIOR TALOFIBULAR LIGAMENT.
4. MILD ACHILLES TENDINOSIS WITH MINIMAL RETROCALCANEAL BURSITIS.
5. MID FOOT DEGENERATIVE CHANGE AND OSSEOUS CYSTIC CHANGE SURROUNDING SINUS TARSI.
   
6. SMALL LATERAL TALAR DOME OSTEOCHONDRAL LESION IS SEEN.
   

• What I Got #1...

• The Peroneal Brevis and Peroneal Longus are thin but important muscle/ligaments that run on the outside/back of your leg from the knee down to and around the outside of the foot. I have a partial tear along BOTH of the ligaments at the outside point on your ankle where there is that little bump - like a hinge between you lower leg and foot(see lateral malleolus above). There is also tendonitis and and other chronic inflammation or disturbance to some areas around the tear(the ligaments and sheaths of the ligaments). This is somewhat as a result of and/or, more likely in my opinion, contributed to reason for the tear.
  
• Longus connects on the outside/backside of your knee, runs down the outside/back of the leg and becomes ligament/tendon at your upper ankle. The ligament/tendon crosses under the hinge-like bump on the outside of your ankle (where the ankle seems to connect with the foot) and then wraps underneath your foot to connect on the middle inside of the foot bone(s) (see OS Naviculare).
• Brevis starts about mid way down the lower leg, halfway between the knee and foot - perhaps a bit higher than half-way) and runs down the outside/back of the lower leg also. Brevis runs the same route as longus except brevis becomes ligament/tendon closer to the ankle and where longus exits to wrap under the foot brevis continues a bit connecting on the middle/outside of the foot bone(s).
  

• Tendinosis (aka chronic tendinitis, chronic tendinopathy, or chronic tendon injury) - damage to a tendon at a cellular level.
  
• Lateral Malleolus - the lower extremity (distal extremity; external malleolus) of the fibula is of a pyramidal form, and somewhat flattened from side to side; it descends to a lower level than the medial malleolus. - http://en.wikipedia.org/wiki/Lateral_malleolus
• Tenosynovitis - Inflammation of the Synovial lining surrounding a tendon.
• Synovial lining - the lining of a joint
• Longitudinal - with the grain, i.e. along the muscle/ligament and not across it.
• Distally - away from or far from center.
  

• What I Got #2...

• Inflammation of the Synovial lining surrounding the tendons connecting muscles on the back of my shin to - somewher? I'm thinking Posterior Tibial Tenosynovitis may be inflammation of the synovial lining around my Achilles tendon? Also, the synovial lining thing with the tendon that connects to the middle/inside of my foot(OS Naviculare), and tendons related to the top middle of my foot. Dr Clark said something about arthritis starting to set in here - minor.
  
• other defs...
  
• os navicular, aka navicular bone or center bone of the ankle. Although when I look at the picture, via the os navicular link - see F, it doesn't look like it's related to the ankle but the inside middle of the foot.

• What I Got #3
• Well, click on the link in #3. I have another partial tear there. I'm starting to wonder about all these "partial" tears.
  
• What I Got #4
• According to the definition of tendonosis, it seems I have 'minor' damage to my Achilles tendon at a cellular level. I also have some damage to a fluid filled sac on the back of my foot whose job it is to provide cushion and lubricant between tendons and muscles sliding over bone.
• What I Got #5 & 6
  
• Couldn't find much 'down home' explanation on the last two. Perhaps I'm getting tired. Perhaps 5 is down home enough... mid foot is gettin old yo. Still, I couldn't find concrete definitions and pics for Ossious Cystic Change, Sinus Tarsi, Talar Dome, and Osteochondral Lesion. I tried several different combinations of these including just looking up each term.