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Sports Medicine

HIgh ankle spain- Still pain after 3 months

12/17/2007

Question:

About 3 months ago I suffered an ankle injury. There was no swelling and the injury did not seem to be significant at all, because the very next day I was walking around without much pain, playing golf during the week, etc. It wasnt until about a month later, when I noticed some strange pains and sensations, and realized it still wasnt feeling well enough to return to jogging. So I went to an ortho who diagnosed me with a high ankle sprain and told me to go on crutches for 5 weeks to let the ligaments heal. After the the 5 weeks of non-weight bearing, I still had some pain and then was sent to a foot and ankle specialist and had an MRI. The specialist did more xrays, looked at the MRI, and told me that my high ankle sprain was only "moderate", and that my paroneal tenden had a very slight tear but that wasnt an issue at all. He told me that I should start some rehab and gradually increase my activity. Ive been doing this, however my ankle still hurts. Everyday I have alot of soreness and some pain, and when I am out walking and step on uneven ground I still get that "sprained ankle" feeling. What is most concerning to me is that it has been 3 MONTHS and it is still not possible to jog without pain or to have any speed burst off my ankle. It is still weak, sore, and bothersome. The pain however is nothing very severe, just moderate pain. All I know is that the pain in my ankle joint doesnt really seem to be improving very much. I can deal with it just walking and stuff, but I really want to return to running and working out. Is this normal to have pain this long ? Is this just a really slow healing injury in some causes, or is it possible I might have a permanent "bum" ankle? It doesnt make sense to me how 3 months later I still have pain. Is it possible I could need reconstuctive surgery, or is it possible the damage to my paroneal tendon is the issue? Please give me any advice you can. Thankyou.

Answer:

A "high ankle sprain" is a more severe injury than the much more common inversion ankle sprain. (if you search within the NetWellness website using the term "high ankle sprain", you'll obtain several results, which you are also encouraged to read.)

A high - or any - ankle sprain is typically very painful initially... for significant pain to be delayed a month is unusual. It takes 2 to 3 times longer - weeks to months - to recover from a high ankle sprain, compared to inversion ankle sprains. However, if you're not experiencing significant improvement 3 months after injury, your diagnosis may need to be re-evaluated. If your symptoms are, indeed, due to a high ankle sprain, there may be instability or looseness of your ankle joint which wouldn't be revealed with plain X-rays nor an MRI scan. Rather, sometimes "stress X-rays" are necessary to depict excessive joint laxity. Also, a plain MRI scan doesn't necessarily show all problems. One reason could be image quality less than perfect. Another possibility is there could be injury to ankle cartilage which would be better seen with a contrast-enhanced MRI ("MR/arthrogram"), where contrast is injected into the ankle joint immediately prior to the ankle MRI scan.

You mentioned you've been doing rehab, but if this hasn't been under the supervision of a Physical Therapist, formal P.T. would certainly be worth considering. Anti-inflammatory medication by mouth, possibly an ankle steroid injection, trial use of one or more types of ankle brace, and cross-training to improve your cardiovascular fitness are additional considerations to keep in mind and discuss with your physician.

Although it would seem less than likely you'll need surgery since neither the initial orthopedist nor the foot/ankle specialist mentioned surgery as being likely, this assumption, however, depends on your actual diagnosis. As far as whether the peroneal tendon tear accounts for your symptoms, the foot and ankle specialist indicated it was not an issue... that physician should be able to explain to you the basis for that opinion.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University