Ankle Sprain: Injury Advice

Hello,

     About 5 weeks ago, I fell and the foot began to swell and turn to a purplish shade within about 5 minutes. I ended up in the E.R, being diagnosed with a bad sprain, and it was put in a splint for a week. Although I stayed off of it completely for that time, the swelling, pain, or coloring had not improved at all.

     In a visit to another orthopedist, he diagnosed it as a chip fracture, caused by tearing a ligament with the bone. He put it in a cam walker originally for 3 weeks. After those weeks, he looked at it again, but the swelling had not gone down very much, and the pain seemed to have increased, if possible.

Dr Blake's comment: With a 3rd degree sprain with chip fracture, swelling is going to take 4 to 5 months to go down. It never goes down when you are immobilized, as the velcro straps above the ankle will prevent the swelling from going back towards your heart. You can help this with compression within the walker, elevation, massage, PT, acupuncture, contrast baths, and various salves. You will see the first real reduction in swelling when you can walk normal with the cam walker for 2 straight weeks. The second reduction in swelling occurs when you have been able to wean successfully out of the walker and are in the Aircast brace full time. 

   He said to leave it in the boot for 3 more weeks, later transferring it to an air cast, before beginning therapy. But now, a week before the follow up, the foot hurts more every time I put pressure on it. The pain is not in the ankle, but in the inside of the foot and the heel. The swelling has gone down a bit, but the bruising has returned, and the pain is becoming more unbearable. Is it possible more than one ligament has been torn and this may require surgery?

Dr Blake's comment: 30 years ago, in the infancy of sports medicine as a discipline, doctors and physical therapists were encouraging mobilization for ankle sprains, not immobilization. I definitely feel this needs to be tailored to each individual, but immobilization can lead to all your symptoms. When you sprain an ankle, you may have an obvious injury, and several less obvious injuries (minor or severe). Since you are having more pain, the obvious thing to do this next month is to get some other test your doc feels appropriate (MRI, bone scan, other xrays, etc) and to re-create a pain free environment (different boot, out of the boot, crutches more, or some obvious change in your activity). Typically with your injury I would have you in PT within the first week. The PT can successfully work on the swelling, find sources of pain, re-create a pain free environment, and give great feedback to the doc treating. Surgeries for torn ligaments, even with chip fractures, are done 9 to 12 months after the injury when the PTs can not find a way to get you functionally stable (where you feel a small crack in the road will cause a sprain). I sure hope this helps you some. Rich