Ankle Sprains: Recovery from Ligament Tears and Nerve Issues

Right ankle sprain with partial tear of the anterior talofibular ligament and calcaneofibular ligament?

Hello Doctor, on September 23rd, I missed a step on the stairs at work, resulting in immediate swelling of my ankle (about the size of a grapefruit).
I applied ice and went to the emergency room for an X-ray, which showed no fractures or dislocations.
The doctor prescribed anti-inflammatory medication.
On September 25th, I had a rehabilitation appointment and was scheduled for an ultrasound.
The ultrasound report on September 28th indicated partial tears of the anterior talofibular ligament and calcaneofibular ligament, with the doctor stating it was a grade 1-2 injury.
Rehabilitation was arranged, including hydrotherapy, electrical stimulation, and ultrasound.
On September 30th, I also had rehabilitation.
Currently, my foot is swollen, and I experience pain when touching the fibula's tip, the anterior talofibular ligament, the calcaneofibular ligament, and the distal fibula; pressing too hard causes significant pain.
There are also bruises on my heel and the inner side of my ankle.
At night, when I elevate my foot, I experience numbness in my toes and the sole of my foot.
I have been doing up-and-down movements with my foot and stretching my toes, but I noticed that I cannot fully extend my toes and have lost control over them.
Doctor, could this indicate nerve damage? I am wearing an ankle brace and can walk and stand, but not for too long.
I am not using crutches, but going up and down stairs is painful (possibly due to the ankle brace rubbing against the fibula's tip).
How long do you think it will take to recover? Thank you.

Mr. Zhang, 30~39 year old female. Ask Date: 2020/10/01

Dr. Zhan Xian reply Orthopedics

Hello Mr.
Chang, a physical examination is needed to answer your question more accurately, which typically takes one to two months.

Reply Date: 2020/10/01

More Info

Ankle sprains are a common injury that can occur when the ankle is twisted or turned in an awkward way, leading to damage to the ligaments that support the joint. In your case, it sounds like you have sustained a significant injury, with ultrasound results indicating partial tears of the anterior talofibular ligament and calcaneofibular ligament, classified as grade 1-2 sprains. This means that while the ligaments are not completely torn, they are damaged enough to cause pain, swelling, and functional limitations.

Recovery Process
The recovery from an ankle sprain, particularly with ligament tears, can vary significantly depending on the severity of the injury, the treatment provided, and individual healing responses. Here are some key points to consider regarding your recovery:
1. Initial Treatment: The RICE method (Rest, Ice, Compression, Elevation) is crucial in the early stages of recovery. You mentioned using ice and elevating your ankle, which is excellent. Continuing to rest and avoid putting weight on the injured ankle will help reduce swelling and pain.

2. Physical Therapy: Engaging in physical therapy, as you have started, is essential. Therapies such as ultrasound, electrical stimulation, and water therapy can help reduce swelling and pain while promoting healing. Your therapist will likely guide you through exercises to restore range of motion, strength, and stability to your ankle.

3. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Ensure you follow your physician's advice regarding medication.

4. Gradual Return to Activity: As your pain decreases and your range of motion improves, you will gradually be able to return to normal activities. However, it’s essential to listen to your body and not rush the process, as doing too much too soon can lead to re-injury.

Nerve Issues
You mentioned experiencing numbness in your toes and difficulty controlling the extension of your toes. This could indicate nerve involvement, possibly due to swelling compressing nearby nerves or direct trauma to the nerves during the injury. The peroneal nerve, which runs along the outside of the knee and down to the foot, can be affected in ankle injuries.
If the numbness persists or worsens, it is crucial to discuss this with your physician. They may recommend further evaluation, such as nerve conduction studies, to assess the function of the nerves in your ankle and foot.

Timeline for Recovery
The recovery timeline for ankle sprains can vary:
- Grade 1 Sprains: Typically heal within a few days to a week.

- Grade 2 Sprains: May take several weeks (2-6 weeks) to heal, depending on the extent of the ligament damage and adherence to rehabilitation protocols.

- Grade 3 Sprains: Involve complete tears and may require surgical intervention, with a longer recovery period.

Given your current symptoms, including swelling, bruising, and pain, it may take several weeks for you to return to full function. It is essential to follow up with your healthcare provider regularly to monitor your progress and adjust your rehabilitation plan as needed.

Conclusion
In summary, while your ankle sprain is significant, with appropriate care, rehabilitation, and time, you can expect to recover. Pay close attention to your symptoms, especially regarding any nerve-related issues, and maintain open communication with your healthcare team. They can provide the best guidance tailored to your specific situation, ensuring a safe and effective recovery process.

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