Ankle Sprains: Recovery Challenges and Treatment Options

Ankle sprain

Hello Doctor: In mid-November last year, I accidentally missed a step while going downstairs, and my right ankle immediately swelled up.
At that time, I asked a colleague to help me apply ice, and later that evening, I went to an orthopedic doctor who took an X-ray and confirmed there were no fractures.
The doctor wrapped my ankle with an elastic bandage (which I was instructed to use only while walking).
That night, the pain was so severe that I couldn't walk, and I even felt spasms in my stomach.
The next day, when I removed the bandage, I noticed bruising around my ankle, so I went to a traditional Chinese medicine clinic that evening for treatment.
After another day, when I removed the herbal wrap, my foot started to itch and showed signs of an allergic reaction, with the bruising spreading to my entire foot, turning a dark purple color from the ankle to the toes.
Due to work requirements, I had to keep moving, and eventually, the bruising spread to my toes as well.
After more than a week, I requested a week off from work to rest.
A week later, the bruising did dissipate; however, upon returning to work, I noticed new light bruising appeared below my ankle.
After my treatment at the traditional Chinese medicine clinic, I began attending physical therapy with a Western medicine doctor, who mentioned that the bruising would resolve in a week and that I would recover in a month.
However, after completing four sessions in a month, my ankle remained swollen, and after one or two additional sessions, I decided to discontinue treatment.
During the Spring Festival, I noticed a few times that the color of my right toes appeared grayish-black, darker than my left foot (which is naturally colder during cold weather).
I was concerned that my foot injury might be affecting blood circulation, so I resumed treatment.
This time, I went to a traditional Chinese medicine clinic, but I still experienced allergic reactions to the herbal wraps, so I applied them every few days and added a piece of medicated cloth between the ointment and my skin.
The doctor performed massage therapy on my ankle and said it had improved, but I felt it was even more swollen.
Moreover, over a month after the injury, I began to experience occasional pain in my left ankle.
The traditional Chinese medicine doctor suggested that this was due to my unstable posture from prolonged walking, and he noted some mild swelling in my left ankle as well.
I would like to ask the doctor why, after nearly three months, my foot still appears as swollen as it did immediately after the injury.
I have never experienced such a severe sprain with extensive bruising, and it has not healed for this long.
What would be the best treatment for my situation, and should I undergo any specific examinations? If I choose not to continue treatment, would applying heat to the injured area be beneficial? Thank you!

tina, 20~29 year old female. Ask Date: 2004/02/06

Dr. Pan Yingda reply Rehabilitation

It shouldn't be like this; even with a fracture, it should have healed in three months.
The initial swelling and bruising indicate that the injury was quite severe.
The spread of bruising is just blood that has pooled under the skin and moved to other areas; this does not signify anything significant.
Since I cannot see your condition, I can only discuss some commonly overlooked aspects from a rehabilitation perspective:
1.
The ankle consists of eight small bones, which may have been dislocated due to a sprain, so it is essential to realign these small bones first.

2.
Since the acute phase has passed, the management of post-injury tissues must focus on the recovery phase.

a.
Joint mobility: After the injury, the movement of the foot decreases, and the resulting tissue damage can lead to adhesions, which may cause joint stiffness and poor circulation.
Therefore, it is necessary to enhance joint mobility.

b.
Soft tissue massage: Injured tissues can easily develop scar tissue and adhesions, so deep tissue massage is recommended.

3.
Functional rehabilitation: Stretching and strength training.
A common reason for poor recovery is the dislocation of the small bones not being corrected, followed by fear of movement and excessive protection.
An X-ray can be taken again, but heat therapy may not be very helpful.
If you are in Taitung, I would like to assess your condition to see if I can assist you.

Reply Date: 2004/02/06

More Info

Ankle sprains are common injuries that can lead to significant discomfort and prolonged recovery times. Your experience highlights several important aspects of ankle sprain recovery, including the initial injury response, treatment options, and potential complications that can arise during the healing process.

When you initially sprained your ankle, the immediate swelling and bruising were typical responses to the injury. The body reacts to trauma by increasing blood flow to the area, which can lead to swelling and bruising as blood vessels are damaged. The use of ice and compression (like the elastic bandage you mentioned) is a standard first-aid approach to manage swelling and pain. However, it’s crucial to ensure that the compression is not too tight, as this can impede circulation and exacerbate swelling.

The fact that you experienced significant bruising and swelling that spread to your toes is concerning. This could indicate that the injury was more severe than initially assessed, or it may suggest complications such as a hematoma (a localized collection of blood outside of blood vessels) or even a possible injury to the ligaments or tendons around the ankle. The presence of persistent swelling and discoloration after several weeks warrants further evaluation.

In terms of recovery, it is essential to follow a structured rehabilitation program. Physical therapy can be beneficial in restoring strength, flexibility, and range of motion to the injured ankle. If you have not already done so, consider consulting a physical therapist who can provide tailored exercises and modalities to aid in your recovery. They can also assess your gait and balance, which may help address the pain in your left ankle due to compensatory movements from the injury.

Regarding your concerns about the grayish color of your toes, this could be a sign of poor circulation or nerve involvement, especially if you are experiencing coldness in your extremities. It is advisable to consult a healthcare professional for a thorough examination, which may include imaging studies (like an MRI or ultrasound) to assess for any underlying issues that may not have been evident on the initial X-ray.

If you are considering whether to continue treatment or rely solely on heat therapy, it’s important to note that while heat can help with muscle relaxation and pain relief, it may not be sufficient for addressing the underlying issues related to your ankle sprain. Continuing with a structured rehabilitation program, including both physical therapy and possibly further medical evaluation, is likely to yield better outcomes than relying on heat alone.

In summary, your situation is not uncommon, and recovery from an ankle sprain can vary significantly from person to person. Persistent swelling and discoloration after several months should be evaluated by a healthcare professional to rule out any complications. Engaging in a comprehensive rehabilitation program is crucial for restoring function and preventing future injuries. If you have concerns about circulation or nerve function, do not hesitate to seek further medical advice.

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