Persistent Ankle Sprain: When to Consider MRI for Healing

Ligament strain with inflammation that has not healed for a long time?

Hello Dr.
Hong, I previously injured my foot while running.
It was a bit painful, but I continued to run until I noticed swelling on the side of my ankle, at which point I sought treatment from a traditional Chinese medicine practitioner.
However, after ten days of treatment, it still hasn't improved.
Although the swelling has decreased, it tends to swell again after walking, so it hasn't healed completely.
I've been wearing a foot brace for protection while walking, only removing it when I return to work.
It's been almost a month now.
I've taken Western medicine for a week, and an X-ray indicated a ligament strain with inflammation, but there is still some swelling.
It seems that every time I start walking, the swelling recurs.
I would like to ask the doctor if an MRI is necessary to see if another practitioner can help realign the ligaments.
Thank you!

Natalie, 20~29 year old female. Ask Date: 2016/07/22

Dr. Hong Ximing reply Orthopedics

Knee ligament sprains that continue to be exercised without adequate rest can lead to more severe injuries.
An MRI may only reveal swelling in the affected area.
It is recommended to wear an ankle brace for 6-8 weeks and to soak the foot in warm water for heat therapy, followed by a follow-up with the attending physician in the outpatient clinic.

Reply Date: 2016/07/22

More Info

When dealing with a persistent ankle sprain, especially one that has not improved significantly after a month of conservative treatment, it is crucial to consider further imaging studies, such as an MRI (Magnetic Resonance Imaging). An MRI can provide a detailed view of the soft tissues in the ankle, including ligaments, tendons, and cartilage, which are not visible on X-rays.
In your case, since you have experienced swelling and pain that persists despite treatment, an MRI may be warranted to assess the extent of the injury. The fact that you have been experiencing recurrent swelling after walking suggests that there may be underlying issues that need to be addressed. An MRI can help identify any potential tears in the ligaments, such as the anterior talofibular ligament (ATFL) or the calcaneofibular ligament (CFL), which are commonly injured during ankle sprains. It can also reveal any associated injuries, such as cartilage damage or bone bruises, which could contribute to your ongoing symptoms.

The typical protocol for managing an ankle sprain includes rest, ice, compression, and elevation (RICE), along with anti-inflammatory medications. However, if there is no significant improvement after a few weeks, further evaluation is necessary. An MRI can provide valuable information that can guide treatment decisions. For instance, if a significant ligament tear is identified, more aggressive treatment options, such as physical therapy or even surgical intervention, may be considered.

Regarding your question about whether the treatment you received from the other practitioner was effective, it is essential to understand that while manual therapy can be beneficial for certain conditions, it may not always be sufficient for more severe injuries. An MRI can help clarify the situation by providing a clear picture of the injury's nature and severity.

In summary, given your ongoing symptoms and the fact that the swelling recurs with activity, it would be prudent to discuss the possibility of an MRI with your healthcare provider. This imaging study can help ensure that you receive the appropriate treatment for your ankle injury, potentially leading to a quicker and more complete recovery. Remember, the goal is to return to your normal activities without pain or swelling, and understanding the full extent of your injury is a critical step in achieving that goal.

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