Ankle Pain: Ligament Injury Recovery and Symptoms Explained

Is your right ankle feeling uncomfortable?

Hello Doctor: I sprained my ankle while playing basketball at the end of October last year.
I went to Clinic A for an ultrasound diagnosis, and the doctor said the ligament was torn.
However, when I later visited doctors at Clinics B and C, they stated it was a partial tear and that X-rays showed no issues with the bones, just a slight separation between the tibia and fibula above the ankle.
I have been undergoing both traditional Chinese medicine and Western rehabilitation, and although I can walk normally now and maintain single-leg standing for about 40 seconds, I still experience discomfort around the ankle, even mild pain.
When I attempt to run or put weight down, I suddenly feel a sharp pain in my heel.
In the morning, my ankle feels tight and somewhat uncomfortable, but this gradually subsides after applying heat.
Doctor, I would like to ask hypothetically: if my ligament were completely torn, what would my ankle condition be like now? And if it were a partial tear, what would my ankle condition be? It has been four months; is the ligament still not healed, or could this be an inflammation issue?

BEAR, 20~29 year old female. Ask Date: 2017/02/09

Dr. Shi Guozheng reply Orthopedics

Ligament injuries typically heal in about three months; however, if there is laxity, it may lead to instability, resulting in inflammation and pain.
The X-ray shows slight separation between the tibia and fibula, which could indicate a distal tibiofibular joint separation.
It is advisable to consult a physician for further evaluation.

Reply Date: 2017/02/09

More Info

Understanding ankle pain, particularly after a ligament injury, is crucial for effective recovery and management. Based on your description, it seems you sustained an ankle injury while playing basketball, which was diagnosed as a ligament tear. The subsequent evaluations indicated a partial tear rather than a complete rupture, which is a critical distinction in terms of recovery and rehabilitation.

Ligament Injury Recovery
When a ligament is injured, the body initiates a healing process that can take several weeks to months, depending on the severity of the injury. A complete tear may require surgical intervention, while a partial tear often heals with conservative management, including rest, ice, compression, elevation (RICE), and physical therapy.

In your case, since you are able to walk normally and maintain balance on one foot for 40 seconds, it suggests that your injury is healing, albeit not completely. The discomfort and occasional pain you experience, especially during activities like running or jumping, may indicate that the ligament is still in the healing phase. Ligaments have a limited blood supply, which can slow down the healing process.

Symptoms Explained
1. Persistent Discomfort and Pain: The discomfort around the ankle, especially when attempting to run or during specific movements, could be due to several factors:
- Residual Inflammation: Even after several months, inflammation can persist, leading to pain and discomfort. This is often exacerbated by activity.

- Scar Tissue Formation: As the ligament heals, scar tissue may form, which can be less flexible than the original ligament, leading to tightness and discomfort.

- Muscle Weakness: After an injury, surrounding muscles may weaken due to disuse, leading to instability and discomfort during movement.

2. Electric Shock Sensation: The "electric" pain you feel in your heel could be related to nerve irritation or entrapment, which can occur after an injury. This sensation may also be linked to the way you are compensating for the injury, leading to altered biomechanics that stress other structures in the ankle.

3. Morning Stiffness: The tightness you feel upon waking is common after an ankle injury. It can be due to fluid accumulation overnight or stiffness in the ligaments and surrounding tissues. Gentle stretching and warm-up exercises can help alleviate this stiffness.

Recovery Timeline
At four months post-injury, it is not unusual for some symptoms to persist, especially if the injury was significant. Ligaments can take anywhere from 6 weeks to several months to heal fully, depending on the extent of the injury and the individual's healing capacity. If you are still experiencing significant discomfort, it may indicate that the ligament has not fully healed or that there is an underlying issue, such as chronic inflammation or instability.

Recommendations
1. Continued Rehabilitation: Engage in a structured rehabilitation program focusing on strengthening the ankle and improving flexibility. This may include exercises for the surrounding muscles, proprioceptive training, and gradual return to activities.

2. Consultation with a Specialist: If symptoms persist or worsen, consider consulting an orthopedic specialist or a sports medicine physician. They may recommend imaging studies, such as an MRI, to assess the status of the ligament and surrounding structures.

3. Pain Management: Over-the-counter anti-inflammatory medications may help manage pain and inflammation. However, consult your healthcare provider before starting any medication.

4. Activity Modification: Gradually return to sports and high-impact activities. Listen to your body and avoid pushing through pain, as this can lead to further injury.

In summary, your symptoms are not uncommon following a ligament injury, and while healing is underway, it is essential to continue monitoring your condition and adjust your rehabilitation accordingly. With proper care and attention, you can expect to see improvement over time.

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