Persistent Ankle Injury: When to Seek Further Medical Treatment

Ankle injury that is slow to heal?

Hello: I sprained my left ankle on the evening of October 7, resulting in swelling at the ankle joint and severe pain that prevented me from standing.
The next day, I visited an orthopedic clinic for examination and X-rays.
The doctor diagnosed a ligament tear in the ankle joint, advised me to rest, and recommended purchasing a strong elastic ankle support.
I was also prescribed anti-inflammatory medication and a topical analgesic.
To be cautious, I went for another examination at China Medical University on October 9.
After reviewing the X-rays, the orthopedic physician diagnosed it as an ankle ligament strain and only provided another tube of topical medication, advising me to buy an ankle brace without explaining further treatment options.

Over a month has passed, and my ankle still has no mobility, the swelling has not completely subsided, my toes feel stiff, the sole of my foot is painful and somewhat swollen, and the temperature of my left foot is noticeably lower than that of my uninjured right foot.
Should I rely solely on the ankle brace and topical analgesic for recovery, or should I consider other medical treatments? Thank you!

miao, 30~39 year old female. Ask Date: 2000/11/17

Dr. Ye Qingnian reply Orthopedics

An ankle sprain without a fracture is always a ligament injury.
The primary function of ligaments is to maintain joint stability.
When injured, they need to be immobilized for six weeks to heal properly.
If the ligaments are not adequately stabilized during the initial six weeks post-injury, they may heal improperly, leading to arthritis later on.
Generally, for mild injuries, an ankle brace should be used for six weeks, while more severe injuries may require a cast for six weeks.
Pain relief ointments only address the symptoms and do not treat the underlying issue.

Reply Date: 2000/11/17

More Info

It sounds like you are experiencing a persistent ankle injury that has not improved despite following initial medical advice. Given the details you've provided, it is crucial to address your concerns about the ongoing symptoms and the effectiveness of your current treatment plan.

Firstly, it is important to understand that ankle sprains, particularly those involving ligament injuries, can vary significantly in severity. A mild sprain may heal with rest, ice, compression, and elevation (the RICE method), while more severe sprains, especially those involving complete ligament tears, may require more intensive treatment. The fact that you are still experiencing significant swelling, pain, and loss of function two months after the injury suggests that your injury may be more severe than initially assessed.

Here are some key points to consider regarding your situation:
1. Persistent Symptoms: The ongoing swelling, pain, and stiffness in your ankle, along with the temperature difference between your injured and uninjured foot, indicate that your injury may not be healing properly. This could be due to several factors, including inadequate rest, improper rehabilitation, or even an undiagnosed fracture or other soft tissue injury.

2. Need for Further Evaluation: Given that your symptoms have persisted for over two months, it is advisable to seek further medical evaluation. A follow-up with an orthopedic specialist is recommended, and you may want to request advanced imaging studies such as an MRI. An MRI can provide detailed images of soft tissues, including ligaments, tendons, and cartilage, which may help identify any underlying issues that X-rays cannot detect.

3. Rehabilitation: If you have not already started a structured rehabilitation program, this is essential for recovery. Physical therapy can help restore range of motion, strength, and function to your ankle. A physical therapist can design a personalized rehabilitation program that includes exercises to improve flexibility, strength, and proprioception (the sense of joint position).

4. Potential for Surgery: In cases where there is a complete tear of the ligaments or if conservative treatment fails to provide relief, surgical intervention may be necessary. This is typically considered if there is significant instability in the ankle joint or if other structures (like cartilage) are damaged.

5. Pain Management: While topical pain relief ointments can provide temporary relief, they are not a substitute for addressing the underlying injury. If pain persists, discuss with your doctor about other pain management options, which may include oral medications or injections.

6. Activity Modification: Until you have a clear diagnosis and treatment plan, it is important to modify your activities to avoid further aggravating the injury. Continuing to engage in activities that put stress on the ankle can lead to chronic issues.

In summary, your current symptoms suggest that further medical evaluation is warranted. It is important to advocate for your health and seek a second opinion if necessary. A comprehensive approach that includes imaging, potential physical therapy, and possibly surgical evaluation will provide the best chance for recovery. Remember, healing from an ankle injury can take time, and addressing it promptly can help prevent long-term complications.

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