Persistent Ankle Swelling After Sprains: Causes and Solutions

The ankle sprain has not resolved or reduced swelling?

I have two questions.
First, my ankle was sprained over three years ago while skateboarding, and since then, I have frequently sprained it again.
After treatment and recovery, my ankle has not returned to its normal size; it remains swollen.
I can confirm that it is not the ligaments or tendons that are swollen, but rather the ankle bones have expanded outward.
When I press on it, I can feel the bone underneath.
Even after a long period without re-injury, there are no signs of it shrinking.
Second, after the injury, I was able to regain full mobility after some time, but during recovery, I still experience pain in the middle, inner part of the ankle when I stand on my tiptoes, which is not related to the ligaments.
Thank you for your hard work, doctors.

Huábǎn Wáng, 10~19 year old female. Ask Date: 2019/07/17

Dr. Zhan Xian reply Orthopedics

Please go to the hospital for orthopedic evaluation and imaging studies!

Reply Date: 2019/07/17

More Info

Persistent ankle swelling after sprains can be a frustrating and concerning issue, especially when it lingers for years after the initial injury. Based on your description, it seems that you have experienced multiple ankle sprains over the past three years, and despite treatment and rehabilitation, you are left with persistent swelling and discomfort. Let's break down the potential causes and solutions for your situation.

Causes of Persistent Ankle Swelling
1. Chronic Inflammation: After repeated sprains, the ankle may develop chronic inflammation. This can occur if the ligaments and surrounding tissues have not fully healed, leading to ongoing swelling. Inflammation can be exacerbated by activities that put stress on the ankle, even if they seem minor.

2. Joint Instability: Repeated ankle sprains can lead to joint instability. If the ligaments that support the ankle are stretched or torn, the joint may not function properly, leading to swelling and pain. This instability can also cause the bones to shift slightly, which might explain the sensation of the ankle bones feeling larger or more prominent.

3. Bone Changes: Over time, repeated trauma to the ankle can lead to changes in the bone structure. This might include bone spurs or other bony growths that can contribute to swelling and discomfort. The sensation of pressing down and feeling bone could indicate that the surrounding soft tissue has atrophied or that there is a change in the bone structure itself.

4. Tendonitis or Tenosynovitis: The pain you experience when standing on your toes could be related to tendonitis or tenosynovitis, conditions that involve inflammation of the tendons around the ankle. This can occur after an injury and may not resolve without appropriate treatment.

5. Scar Tissue Formation: After an injury, scar tissue can form in the ankle joint, which may restrict movement and cause discomfort. This can lead to a sensation of tightness or pain during certain movements, such as standing on your toes.

Solutions and Recommendations
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide exercises to strengthen the ankle, improve stability, and enhance range of motion. They can also employ modalities such as ultrasound or electrical stimulation to reduce inflammation.

2. Rest and Ice: If you notice swelling after activity, it’s important to rest the ankle and apply ice to reduce inflammation. Elevating the ankle can also help decrease swelling.

3. Bracing or Taping: Using an ankle brace or taping the ankle during activities can provide additional support and stability, potentially preventing further injury and allowing the ankle to heal properly.

4. Gradual Return to Activity: It’s crucial to gradually return to physical activities, especially those that involve lateral movements or jumping. Start with low-impact exercises and slowly increase intensity as tolerated.

5. Consultation with a Specialist: If the swelling and pain persist despite conservative measures, it may be beneficial to consult with an orthopedic specialist. They may recommend imaging studies, such as an MRI, to assess for any underlying issues such as ligament tears, cartilage damage, or bone abnormalities.

6. Medication: Over-the-counter anti-inflammatory medications (like ibuprofen) can help manage pain and swelling. However, it’s important to use these as directed and consult with a healthcare provider if you have any concerns.

7. Surgical Options: In cases where conservative management fails, surgical intervention may be considered. This could involve repairing damaged ligaments, removing bone spurs, or addressing any structural abnormalities in the ankle.

In conclusion, persistent ankle swelling and pain after multiple sprains can be attributed to a variety of factors, including chronic inflammation, joint instability, and potential changes in bone structure. A comprehensive approach that includes physical therapy, proper rest, and possibly consultation with a specialist will be essential in managing your symptoms and improving your ankle function. Always consult with a healthcare professional before starting any new treatment or exercise regimen.

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