Persistent Foot Pain After a Sprain: Causes and Solutions

Foot pain

Hello Doctor: Last month I sprained my ankle.
Initially, I had difficulty walking, but now I can walk without pain and there is no pain when I move it.
However, it still hurts a little when I touch it, and it has been a month since the injury.
I had an X-ray at that time, which showed no bone damage.
Why could this be happening? The doctor mentioned that it might be a rupture of the periosteum.
Can this be seen on an X-ray? What should I do? Thank you!

felix, 20~29 year old female. Ask Date: 2001/04/05

Dr. Shi Guozheng reply Orthopedics

Ankle injuries typically involve damage to the ligaments, with the lateral ligaments being the most commonly affected.
There are three ligaments on the lateral side of the ankle, and the anterior talofibular ligament is the most susceptible to injury.
Following an injury, there may be bleeding or swelling, and severe pain can persist for about three to four weeks, while a typical ligament injury may take over six weeks to heal.
Due to bleeding at the time of injury, joint mobility may be restricted.
Initially, ice should be applied to help control bleeding and alleviate pain, and heat can be applied after 24 hours to reduce swelling.
Inadequate treatment can delay joint recovery and may lead to ligament laxity, making the joint more prone to re-injury.
In such cases, X-rays usually only rule out fractures and cannot diagnose what is known as a synovial injury (please refer to previous Q&A sets).
In addition to medication, rest and rehabilitation are crucial.
It is advisable to consult a physician to prevent any potential complications.

Reply Date: 2001/04/05

More Info

Persistent foot pain following a sprain can be a frustrating and concerning issue. It’s great that you’ve already sought medical attention and had an X-ray, which ruled out any fractures. However, the lingering pain you’re experiencing, especially when touching the area, suggests that there may be more going on than just a simple sprain.

Possible Causes of Persistent Pain After a Sprain
1. Soft Tissue Injury: While X-rays are excellent for identifying bone fractures, they do not show soft tissue injuries such as ligament sprains, muscle strains, or tendon injuries. A sprain involves the stretching or tearing of ligaments, which can lead to inflammation and pain that persists long after the initial injury.

2. Bone Bruise: Even if there is no fracture, a bone bruise can occur from the impact during the sprain. This type of injury can cause significant pain and tenderness, especially when pressure is applied.

3. Periosteal Injury: The periosteum is a dense layer of vascular connective tissue enveloping the bones except at surfaces of the joints. If the sprain was severe, it could have caused irritation or injury to the periosteum, leading to localized pain.

4. Tendinitis: Inflammation of the tendons around the ankle or foot can occur after a sprain, especially if you’ve been compensating for the injury by altering your gait or activity level. This can lead to overuse injuries in the surrounding structures.

5. Complex Regional Pain Syndrome (CRPS): Although less common, CRPS can develop after an injury and is characterized by prolonged pain and changes in skin color, temperature, and swelling. It’s important to monitor for any signs of this condition.

Solutions and Recommendations
1. Rest and Ice: Continue to rest the affected foot and apply ice to reduce inflammation. Ice should be applied for 15-20 minutes every few hours, especially after any activity.

2. Compression and Elevation: Use a compression bandage to help reduce swelling and elevate your foot above heart level when resting.

3. Physical Therapy: A physical therapist can provide a tailored rehabilitation program to strengthen the muscles around the ankle and improve flexibility. This can help in recovery and prevent future injuries.

4. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and reduce inflammation. Always consult with your healthcare provider before starting any medication.

5. Gradual Return to Activity: Once the pain subsides, gradually reintroduce activities. Avoid high-impact exercises until you’re fully healed. Low-impact activities like swimming or cycling can be beneficial.

6. Follow-Up Care: If the pain persists or worsens, it’s crucial to follow up with your healthcare provider. They may recommend further imaging studies, such as an MRI, to assess soft tissue injuries that X-rays cannot detect.

7. Footwear: Ensure that you are wearing supportive footwear that provides adequate cushioning and stability. Avoid high heels or shoes that do not support your arch.

Conclusion
In summary, while your X-ray results are reassuring, the persistent pain you’re experiencing may be due to soft tissue injuries or other complications related to the sprain. It’s important to take a proactive approach to your recovery, including rest, physical therapy, and proper pain management. If symptoms do not improve, further evaluation may be necessary to rule out more serious conditions. Always communicate openly with your healthcare provider about your symptoms and concerns to ensure the best possible care.

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