Ankle Sprains: Recovery Tips and Concerns

Ankle sprain

Hello Dr.
Wang,
About six weeks ago, I sustained an inversion ankle sprain while playing basketball after stepping on muddy ground outside the court.
I was wearing high-top basketball shoes, and due to the wet conditions, I twisted my ankle and fell without any external injuries.
After applying ice, I noticed swelling on the lateral side of my ankle.
Since I was abroad and unable to seek medical attention, I had a local massage therapist treat me the next day.
I then used topical ointments and elastic bandages for stabilization daily.
I could rotate my ankle without issues on the same day, but it was painful.

Subsequently, aside from the bruising and swelling around the ankle, I also experienced tenderness and bruising extending about five centimeters along both sides of the fibula.
In the third week post-injury, I returned for another massage, and the therapist mentioned that insufficient rest had led to compensatory injuries in the fourth and fifth toes.
At times, the pain became severe enough to affect the sole of my foot, making it difficult to walk, but that has since improved.
I can rotate my ankle without problems, but certain angles still cause tightness or pain.

To this day, there is still slight swelling and redness in the medial and distal areas of the lateral ankle, and pain occurs only when pressure is applied or at certain angles.
Yesterday, I switched to a different type of elastic bandage, and upon returning home, I noticed swelling in my toes and the front part of my foot.

(1) I am concerned whether this swelling is due to improper bandaging causing poor circulation or if it is a result of ongoing inflammation in the ankle.

(2) I am worried if the prolonged inflammation in my ankle is normal.

(3) I will be returning to Taiwan for medical treatment in about three weeks; I wonder if this delay will hinder my recovery.

(4) If it won't significantly delay treatment, how should I care for and manage my ankle to expedite recovery?
(5) Due to the cold weather and poor blood circulation, I have mild frostbite symptoms (redness and itching) in my toes; I am unsure if this will have any impact.
Thank you for your assistance and response.

yang, 20~29 year old female. Ask Date: 2008/01/22

Dr. Wang Shouji reply Orthopedics

Ankle injuries are most commonly ligament injuries and fractures of the medial and lateral malleolus.
If an injury occurs, it is advisable to seek medical attention immediately to confirm whether there is any bone involvement.
If there is none, conservative treatment should be adopted.
Delayed treatment of fractures can lead to numerous complications.
Poor wrapping and lack of muscle activity can cause edema in the distal extremities.
If there is no significant improvement after one week, it is essential to visit an orthopedic specialist for further evaluation.
Wishing you a speedy recovery.

Reply Date: 2008/01/22

More Info

Ankle sprains are a common injury, particularly among athletes, and can lead to significant discomfort and functional limitations. Based on your description, it seems you are experiencing a moderate to severe ankle sprain, which has resulted in persistent swelling, bruising, and pain. Here are some insights and recommendations regarding your concerns:
1. Circulation Issues from Bandaging: It is crucial to ensure that any compression bandaging is applied correctly. If the bandage is too tight, it can impede circulation, leading to increased swelling and discomfort. Signs of poor circulation include numbness, tingling, increased pain, or a change in color of the toes. If you suspect that your bandaging may be too tight, it is advisable to loosen it and monitor the symptoms. If the swelling persists or worsens, it may be necessary to seek medical attention sooner.

2. Duration of Inflammation: It is not uncommon for inflammation to last several weeks after an ankle sprain, especially if the injury was significant. The presence of swelling and tenderness around the ankle after six weeks could indicate ongoing inflammation or even the possibility of a more severe injury, such as a ligament tear. While some inflammation is expected, persistent symptoms warrant further evaluation by a healthcare professional.

3. Delay in Treatment: Waiting three weeks to return to your home country for medical evaluation may not necessarily delay treatment significantly, but it is essential to monitor your symptoms closely. If you experience increased pain, swelling, or difficulty bearing weight on the ankle, it may be prudent to seek local medical care before your return. Early intervention can help prevent chronic issues and facilitate a more effective recovery.

4. Self-Care and Rehabilitation: To promote healing and recovery, consider the following self-care strategies:
- Rest: Avoid activities that exacerbate pain. Allow your ankle to rest and heal.

- Ice: Continue to apply ice to the affected area for 15-20 minutes every few hours to reduce swelling and pain.

- Compression: Use an elastic bandage to provide support and minimize swelling, ensuring it is not too tight.

- Elevation: Keep your ankle elevated above heart level when resting to help reduce swelling.

- Gentle Range of Motion Exercises: As tolerated, perform gentle ankle movements to maintain flexibility and prevent stiffness. Avoid any movements that cause pain.

- Gradual Strengthening: Once the acute pain and swelling subside, gradually incorporate strengthening exercises to restore function and stability to the ankle.

5. Cold Weather and Circulation: Cold weather can exacerbate circulation issues, especially if you have underlying conditions affecting blood flow. If you are experiencing symptoms of mild frostbite, such as redness and itching, it is essential to warm your toes gradually and avoid direct heat. If symptoms persist or worsen, seek medical attention.

In summary, while some inflammation and discomfort can be expected after an ankle sprain, persistent symptoms should not be ignored. Proper self-care, monitoring your symptoms, and seeking timely medical advice when necessary are crucial for a successful recovery. If you have any doubts about your condition or if your symptoms worsen, do not hesitate to seek local medical assistance.

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