I have a 13 year old daughter who is a competitive gymnast. 12 weeks ago she sprained her ankle in the gym. She was placed in AirCast for 2 weeks then moved to a lace up brace and attended physical therapy. During week 4 of physical therapy the pain began to get worse and she was referred back to the orthopedic for evaluation. Additionally her ankle began to turn purple from about mid calf to her foot. Sometimes it presents with white spots up within the purple color. Elevation minimizes the discoloration somewhat. Swelling is minimal and x-rays were completely normal. There were no previous injuries to this ankle.
We were referred to a neurologist for evaluation for possible RSD. 3 weeks ago we had a sympathetic nerve block, which was successful, but made no difference in her pain level. Since then we have had an MRI of the foot, ankle, and vascular ultrasound which have shown no abnormalities other than 2 ganglion cysts under a MM in size.
Self reported pain level varies from a 5-8 usually increasing at night. Narcotics are ineffective against the pain. She is still wearing the AirCast "because it hurts too much without it." Without the cast she limps due to pain and limits her activities. Her symptoms are atypical of RSD since touch does not bother her and she prefers to wear a sock on that foot. Physician has prescribed her Neurotin which she will begin this weekend. We are trying to wean her off of AirCast but pain becomes intolerable.
We are at a loss of what to do next. She has trained in gymnastics since she was 4 and has been out of the gym for 4 months now. Do you have any advice or know of any other conditions that we should check for?