Persistent Ankle Pain After Injury: Recovery and Rehabilitation

I sprained my ankle last October, and it hasn't healed yet?

Last October, while playing basketball, I jumped to grab a rebound and twisted my ankle (inversion) when I landed.
I heard a popping sound, and my foot went completely numb.
After about 2 to 3 minutes, the numbness subsided, but I had difficulty walking.
The next day, I wrapped it with an elastic bandage and went to see a rehabilitation specialist.
The doctor said there were no fractures, only a sprain, and that it would heal in two weeks.
However, after two weeks, it still wasn't better, and since there was a competition coming up (I'm not an athlete), I resumed practice, which was quite intense.
After the competition in early December, my ankle was quite swollen.
I didn't overexert myself afterward, just engaged in regular exercise.
I also tried acupuncture, but it didn't seem to help much.
By March of this year, I was still experiencing sharp pain in my ankle (even while sitting in class), so I went back to the doctor for an ultrasound.
The doctor said that two ligaments were lax and there was a bit of fluid accumulation, suggesting rehabilitation would help.
However, after several rehabilitation sessions, I haven't seen much improvement.
Could the pain be due to the lax ligaments? When I sit on my knees, the heel of the injured foot hurts a lot, making it hard for me to sit.
Is this an Achilles tendon injury? That area sometimes hurts as well, but the ultrasound showed no issues there.
Thank you for your response, doctor.

Xiao Bai, 10~19 year old female. Ask Date: 2018/04/23

Dr. Zhou Jianwen reply Rehabilitation

Ankle sprains may involve damage to multiple tissues, and it is recommended to return to the orthopedic clinic for further evaluation and treatment.

Reply Date: 2018/04/23

More Info

Persistent ankle pain following an injury can be a frustrating and complex issue to navigate, especially after experiencing a significant event like an ankle sprain. Based on your description, it seems that you sustained an inversion ankle sprain while playing basketball, which is a common injury that can lead to various complications if not managed properly.

Understanding Your Injury
When you initially injured your ankle, the sound you heard and the immediate loss of function (numbness) are indicative of a significant sprain. An inversion sprain typically affects the lateral ligaments of the ankle, particularly the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). The fact that you experienced swelling and persistent pain even after two weeks suggests that the injury may have been more severe than initially assessed.

Recovery Timeline
Ankle sprains can take anywhere from a few days to several weeks to heal, depending on the severity of the injury. Mild sprains may heal within a week or two, while moderate to severe sprains can take several weeks or even months. Given that you have experienced ongoing pain and swelling, it is crucial to consider that you may have sustained a more significant injury, such as a partial tear of the ligaments or even damage to the surrounding structures, including tendons and cartilage.

Rehabilitation Considerations
1. Physical Therapy: Since you have already started physical therapy, it is essential to continue this process. A physical therapist can provide targeted exercises to strengthen the muscles around the ankle, improve stability, and restore range of motion. Focus on proprioceptive exercises, which help improve balance and coordination.

2. Rest and Activity Modification: It is important to allow your ankle to heal properly. Avoid activities that exacerbate your pain, especially high-impact sports or exercises that put excessive strain on the ankle. Gradually reintroduce activities as your pain decreases and strength improves.

3. Pain Management: If you are experiencing persistent pain, consider discussing pain management options with your healthcare provider. This may include non-steroidal anti-inflammatory drugs (NSAIDs) or other modalities like ice therapy, ultrasound, or electrical stimulation.

4. Addressing Ligament Laxity: The report of "two ligaments being loose" suggests that there may be some instability in your ankle. This can lead to recurrent sprains and chronic pain. Your physical therapist can work on strengthening the muscles that support the ankle and may also recommend bracing during activities to provide additional support.

5. Achilles Tendon Considerations: The pain you experience in your heel while kneeling could be related to the Achilles tendon, especially if there is tightness or inflammation in that area. It is essential to differentiate between ankle pain and Achilles tendon pain, as they require different management strategies. Stretching and strengthening exercises for the calf muscles and Achilles tendon may be beneficial.

When to Seek Further Evaluation
If your symptoms do not improve with rehabilitation, or if you experience increased pain, swelling, or instability, it may be necessary to seek further evaluation. This could include advanced imaging studies such as an MRI to assess for any underlying injuries to the ligaments, tendons, or cartilage that may not have been visible on ultrasound.

In summary, persistent ankle pain after an injury can be multifactorial, often involving ligamentous laxity, muscle weakness, and potential tendon involvement. A comprehensive rehabilitation program tailored to your specific needs, along with proper pain management and activity modification, will be key to your recovery. Always communicate openly with your healthcare providers about your symptoms and progress to ensure the best possible outcome.

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