Question - Ankle Sprain (8 weeks with continued pain)

by Paul
(Fitchburg, MA, US)

My wife sprained her ankle 8 weeks ago and she is still in lots of pain. It still swells up and keeps her awake at night, yet at times it can feel ok for 2-3 days, then the swelling and pain comes back as if it just happened.

She has been going therapy and the therapist says something is not right and doesn't want to treat her anymore, but her foot Dr. says everything is normal and it could take 5-6 months to heal. My wife is 37 years old...

Any help would be appreciated,
Paul

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Mar 07, 2013
what happened, similar problem NEW
by: Anonymous

so whatever happened here.
i fell downstair twisted my ankle and it has a hair line fracture. after 8 weeks and a boot, it swells from time to time really alot around that ankle. I cant say I am in alot of pain but it is freaky to see that much swelling around the ankle and lower leg when i am on it several hours....but then again,i had a friend to tell me she wore a ankle brace for up to 6mths and hers swelled if she was on it too much and she is healed after 6mths

Mar 07, 2013
what happened, similar problem NEW
by: Anonymous

so whatever happened here.
i fell downstair twisted my ankle and it has a hair line fracture. after 8 weeks and a boot, it swells from time to time really alot around that ankle. I cant say I am in alot of pain but it is freaky to see that much swelling around the ankle and lower leg when i am on it several hours....but then again,i had a friend to tell me she wore a ankle brace for up to 6mths and hers swelled if she was on it too much and she is healed after 6mths

Aug 26, 2008
It does take time...
by: Bart - SII

But an ankle sprain, even with an associated fracture (that we assume has healed since she is no longer in the cast) should not have severe swelling (as compared to the initial injury) with walking and ADL's. This is a red flag that there could be some other type of injury - articular in nature, and warrants further diagnostics, if for no other reason than to rule out possible intra-articular injury. Ankle swelling can continue for months after a sprain, but it should be minimal, not like the initial injury.

I would respectfully disagree with the recommendation for heat on an area that is suffering from swelling. Ice and elevation yes, but not heat. If swelling wasn't an issue, I would feel differently.

Bart

Aug 25, 2008
It could take MONTHS
by: Anonymous

Swelling and pain can last up to 12 to 18 MONTHS after something like this. Some people do not realize this. It is very painful and frustrating when people tell you to hurry up and wait. But it is true. It will take time, patience, and she should be icing and elevating that ankle still as well. Also if she starts having tremors or really bad charlie horse -- leg cramps make sure you use moist heat. Icing and heating should always only be done for 10 - 15 minutes at a time.

Jun 24, 2008
So Frustrating...
by: Bart - SII

I hate it when physicians book themselves so busy that they can't take the time to actually listen to their patients concerns!

I do think that a lot of swelling in the ankle after just an hour or so of walking and significant increases in pain are an indicator that there could be something else going on.

It sounds like the therapist is exactly right in that they want to continue to treat her ankle, but are concerned about other problems other than just the sprain and healed fracture. I would highly recommend further diagnostics.

I would talk to the therapist and see if they have a relationship with the physician in that they can persuade further diagnostics. I know that I have this type of relationship with my doctors, and I can often make a call and get tests ordered by the physician based on my clinical findings - not all therapists have this relationship though.

Your PT would also be a good person to talk to about a doctor for a second opinion. Every clinician has their favorite doctors for different types of injuries - ones they use regularly and who the see lots of patients from.

Another place to get a referral is from your primary care / family doctor (if that isn't the one already treating the ankle sprain/fracture). You may also try looking online at your local hospitals website - they often list their physicians and their specailties out on their biography or department pages.

I hope this helps - keep us posted on how your wife progresses - Good luck!

Bart

Jun 24, 2008
More details
by: Paul

She went to turn suddenly and her ankle folded over (taking a left turn, left ankle folded, so the outer side got stretched).

She did indeed have a facture and had to wear an air cast for a while until that healed.

No MRI has been performed at this time. Her last visit to the doctor is why I am asking questions here. He would not take the time to listen to her and drew his own conclusions based on what he wanted to hear, frustrating! He asked if there had been any improvement, and she said "yes, it is 65% better". What she meant was 65% better since it happened, not in the past 3 weeks, but he wrote it up as if it got 65% better in the past few weeks. When she questioned the nurse and tried to explain, the nurse would not listen! The doctor was too busy to talk to her...

Anyhow, the therapist is 100% right in that she wants to treat the ankle, but she wants the foot doctor to peform more tests to see if there is something they have missed. I guess we need to find another doctor who isn't too busy to listen and follow through.

The main problem at this point is that it swells really bad (and is painful) when she is on it for any length of time, but some days it is better than others.

So your recommendation is to find a doctor who will perform an MRI? I guess my question is, after 8 weeks should it still swell (a lot) and be painful after being walked on for an hour? Or is that an indication that something more serious has happened?

Thank you very much for your time!

-Paul

P.S. How can we find the best foot doctor in the Fitchburg/boston area?

Jun 23, 2008
How did she hurt it?
by: Bart - SII

Continued pain 8 weeks after an ankle sprain is not uncommon. However, she should be seeing some improvement.

How did she hurt her ankle? Did they take X-rays after the injury to make sure that there was not a fracture? Has she had any other diagnostic tests, such as an MRI or CT scan?

If she was my patient, I would be concerned after 8 weeks if she was still having pain - much like her PT is...however, instead of not wanting to treat her, I would recommend further diagnostics with the physician. She may be suffering from an ankle sprain, but there could be damage to the articular cartilage within the ankle joint - this would only show up with an MRI or CT scan.

Are there any specific activities that seem to cause increased pain or that cause the ankle to swell up? These can sometimes be an indicator of other problems besides a simple sprain.

As long as she is making some improvements weekly, I would continue with the therapy and give it time...but if she hasn't seen much progress over the last few weeks, then I would recheck with the doctor and make sure that there aren't other diganostics that can be done to make sure there isn't some other type of damage than what was originally thought.

Hope this helps - comment back if you have other questions.

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