Thank you so very much for your email and I am glad that the sesamoiditis has resolved. When I did a study in the 1980s on ankle sprains, I found nearly 20% of all ankle sprain victims still had some symptoms after one year. Only 1-2% of those patients had a significant injury like a missed fracture. The other 98% of these patients had problems, but did not know if they had any significance, and thus were just living with them. The reasons were varied, like still feeling weak or unstable, and approximately 20% of them complained swelling like you. If I do my math correctly, that means 4% of all ankle sprains patients are still having swelling issues after one year post injury.
So, why is this a big deal? The ankle joint is the tightest major weight bearing joint in the body. The tibia (leg bone) and the talus (foot bone) normally fit like a hand and glove. Swelling causes instability by separating the joint surfaces. Add some amount of ligament damage with your typical sprain and more potential instability or wobble can occur. Add the typical sub par re-strengthening program of most ankle sprains, and the potential of significant re-injury occurs. Add the heels that most women want to wear, or the cobble stones streets in Europe, or the months of deconditioning/weakness produced by a new job, move, illness, etc, and more potential for injury occurs.
Question #1: Does the swelling without pain mean something really bad is lurking? Probably not.
Question #2: Should you work aggressively on the swelling with more PT, contrast bathing, elevation, acupuncture, etc? Probably not, although some daily icing with a pack 20 minutes to the front and outside of the ankle is helpful. At least, you can slip inside your sock and walk around the house with an ice pack. Do for the next 2 months, near the end of each day, Also, if your soaks or support hose when you take off produce a visible depression in the skin, this alone may be preventing the fluid from getting back to your heart.
Question #3: What should be your primary focus over the next 2 months? Place yourself on a great ankle restrengthening program with the balance and theraband exercises listed in this blog. Do these for 5 minutes every night within 2 hours of going to sleep to gradually strengthen the ankle and then go to 3 days per week. Over the next year, make sure the time or difficulty increases each month, so you become super strong. Then let me know how you feel. If you do the various exercises, and you can isolate one that hurts you, now we have probably labeled some form of tendinitis and the treatment can be more exacting.
Sure hope this helps you Ann, Rich.