Ankle Sprains: Treatment and Recovery Insights

Ankle sprain

Hello Doctor,
I am currently working in mainland China.
A few days ago, while traveling in a scenic area, I accidentally twisted my right ankle (it rolled inward) on uneven terrain, causing swelling.
At the time, it wasn't extremely painful, but since I was in a tourist area, I had to bear weight on the injured leg and walk a bit, which did cause pain.
I went to see a doctor and had an X-ray taken.
The assessment was as follows: (I apologize for using mainland terminology) 1.
Soft tissue contusion and swelling 2.
A small bone fragment the size of a grain of rice was avulsed from the distal fibula (the lower edge of the ankle) 3.
No fractures or dislocations in the remaining bones, which are normal.
The first point is not a major issue, but the second point is concerning.
In layman's terms, it means that during the injury, a small piece of bone at the distal fibula was pulled off by the ligament.
In mainland terminology, this is referred to as an avulsion fracture (the term fracture can be alarming).
The doctor indicated that it is still a type of fracture, but very mild, and it requires conservative treatment as if it were a fracture.
The best approach is to apply a cast, followed by using an ankle brace (or protective gear as referred to in Taiwan), and lastly, to avoid external fixation and rest as much as possible, minimizing walking and weight-bearing.
Although it is a very mild fracture, improper healing could lead to complications.
I did not get a cast and opted to use an ankle brace when moving, while avoiding external fixation and minimizing walking and weight-bearing to allow for healing (I rest at home but still move around the house to use the restroom, trying to keep my weight on my left foot and dragging my right foot to reduce its load).
Now, on the fourth day, the swelling has started to decrease, and there is no pain upon touching, but there is still some visible bruising.
However, I am still hesitant to try walking on it completely, as I have heard that excessive medical treatment is a concern in mainland China, and I found that in Taiwan, it is rare for ankle sprains to result in avulsion fractures.
I would like to ask my hometown doctor:
1.
Is the condition of having a small bone fragment avulsed serious?
2.
Given that the brace is still inconvenient, is it appropriate to allow for healing without external fixation and minimize movement?
3.
How long does it generally take to recover?
4.
Should I be very cautious about immobilization (keeping the ankle joint at a fixed angle and wearing the brace long-term) or should I focus on avoiding weight-bearing (minimizing walking)? I have read that the fibula is not a primary weight-bearing bone, so it may not be necessary to completely avoid walking; minimizing walking might be sufficient.
Is it really not that serious, as long as I reduce walking and standing, and is it unnecessary to wear a brace?
5.
If the avulsed bone fragment is not properly cared for, is there a possibility of displacement leading to nonunion? If it does not heal, is there a chance it will be absorbed by the body later?
Thank you, Doctor.

Mr. Zheng, 40~49 year old female. Ask Date: 2017/02/16

Dr. Shi Guozheng reply Orthopedics

1.
A tear injury occurs when a ligament pulls a small piece of bone away; it is also a type of ankle sprain and is not particularly severe.

2.
With the use of a brace, light movements can still be performed.

3.
The healing time is typically between six to twelve weeks.

4.
Wear the brace for six weeks; if there is no improvement, it should be worn for up to twelve weeks.

5.
Generally, it will heal and will not be absorbed.

Reply Date: 2017/02/16

More Info

Ankle sprains are common injuries that can vary in severity, and your situation involves a specific type of injury known as an avulsion fracture, where a small piece of bone is pulled away from the main bone by a tendon or ligament. Let's address your questions one by one.

1. Is the small avulsed bone fragment serious?
An avulsion fracture, especially one that is described as "rice grain-sized," is generally considered a minor injury, particularly if the rest of the ankle joint is intact and there are no significant displacements. However, it is still important to treat it properly to ensure that it heals correctly. The fact that your doctor classified it as a fracture means that it requires careful management to avoid complications.

2. Is it suitable to avoid external fixation and rest the ankle?
While resting the ankle and avoiding weight-bearing activities are crucial for recovery, using a brace or support can provide additional stability and protection. The use of an ankle brace can help prevent further injury while allowing for some mobility. If the brace is uncomfortable, you might consider discussing alternative options with your healthcare provider. However, it is generally advisable to use some form of support during the healing process.

3. How long does it typically take to recover?
Recovery time can vary based on the severity of the injury and individual healing rates. For minor avulsion fractures, you might expect a recovery period of 4 to 6 weeks, but this can be longer if there are complications or if you do not adhere to rest and rehabilitation protocols. Regular follow-ups with your doctor can help monitor your progress.

4. Should I be very cautious about immobilization and weight-bearing?
It is essential to take your injury seriously, especially since the avulsed fragment indicates that there was significant stress on the ankle. While the fibula is not the primary weight-bearing bone, it still plays a crucial role in ankle stability. Therefore, minimizing weight-bearing activities and using a brace or support is advisable to prevent further injury. Gradually increasing activity as tolerated, while listening to your body, is key. If you experience pain, it’s a sign to reduce activity.

5. Could the avulsed bone fragment shift and lead to non-union?
There is a possibility that if the avulsed fragment is not properly managed, it could lead to complications such as non-union or malunion. However, many small avulsed fragments can heal well without surgical intervention, especially if they are not displaced. In some cases, the body may absorb the fragment over time, but this is not guaranteed. Regular follow-up with imaging, if necessary, can help assess the healing process.

In summary, while your injury appears to be on the less severe side, it is crucial to follow your doctor's advice regarding rest, immobilization, and gradual return to activity. If you have any concerns about your recovery or if symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation. Proper management now can help prevent long-term complications and ensure a full recovery.

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