Severe Ankle Sprain

[ambersue]

I severely sprained my ankle this past saturday. It has been 4 days. I have had 2 x-rays, both negative (2 days apart) for fracture. I go to my general doctor in 2 days for a follow up exam, and to see if we can tell how bad the ligament damage is. It is black/blue/purple over almost my whole foot/ankle area. The swelling has come down a lot as I used the RICE treatment so far. The doctors put me on crutches, but I am unable to use them, so I have a "knee walker" and it gives me much relief to walk and have mobility back. My question is, what am I looking at in time for me to bear weight and walk again. As of right now, I can gently put my foot on the ground without pain, but can put no pressure on it. I am getting frustrated, and I do know it has only been 4 days, but I am not used to having to limit myself so much. Thanks in advance!

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[physiobob]

Hard to tell via a forum consult but don't be surprised if this takes a good two weeks to walk on

[ambersue]

Just a quick update....this ankle is not just sprained, i have a cortical avulsion of the latteral malleolus. Gonna be a long few weeks I think

[physiobob]

Thanks for the update. Can you let us know how they made the diagnosis? did you have a followup MRI? The lateral malleolus is not weight-bearing but is is loaded with inversion/eversion of the ankle. This might suggest wearing a boot of some sort that lets you weight-bear through the tibia but prevents excessive strain to the lateral ligament complex.

[MrPhysio+]

Hi Ambersue,
The best way to reduce the initial pain following your ankle avulsion fracture is to reduce the amount of swelling - quickly.
The inflammatory fluid creates pressure against the damaged areas (both splinting and compressing sensory nerves causing pain) as well as containing a nerve irritant that increases in concentration the longer the area is kept still - hence increased pain at night.

You can use contrast baths to reduce swelling - Two rectangular mop buckets are needed. Partially one with luke warm water, the other two thirds full of cold water and one third with ice slush leaving enough room to avoid overflow when your foot is immersed. Put your foot into the cold bucket for 20 seconds, then the warm bucket for 20 seconds and repeat the sequence for a total of 5 times. You can do this twice a day. At other times have the leg elevated and gently move your foot backwards and forwards - the contraction relaxation of the calf acts like a pump to assist in fluid removal and gravity helps as well (ankle higher than the knee and knee higher than the hip).

If you are moving around once some swelling is reduced, a tubular compression sleeve is good, but not too tight.

Although this is a bit controversial, I prefer my patients not to take non steroidal anti inflammatories in the acute post injury stage as they can interfere with healing times and increase bleeding. The idea of a cam boot is a good one, allowing you to get around whilst supporting the ankle.

Once you have stabilisation of the fracture it is very important to start ankle balance exercises as your balance will be badly affected and if not retrained will increase your chance of further ankle injury.

Let us know how you proceed with your healing rehab.
Regards,
MrPhysio+

[ambersue]

It was found by my MD on the 2nd set of x-rays, I have a follow-up appointment tomorrow afternoon, and am expecting an MRI appt scheduled to fully see the problems.

I am currently in an aircast with an ace bandage on the outside for stability/compression. I do take it off in the evening when I am resting with my leg up and try to move my ankle in small non painful movements. I am at zero weight bearing, I can put pressure on it, but the doctor says not to right now. I am aggrevated with the pain and being dependent on others for help.

My pain is pretty constant, but I am waking up with severe pain at night, so I am very tired from not sleeping much. I am also already using the cold water/ warm water thing to help heal this bad boy. The swelling is not too bad anymore, just on the back outside of my ankle where the avulsion is, there is still swelling and some in my foot at the end of the day after work. I also still have bruising all over the ankle (inside and out) and on the top of my foot. I work at a sit down job and keep my foot elevated as best I can through out the day.

Okay, so I will stop my whining now. I am looking forward to seeing my doctor tomorrow so we can get on with this process of how to get me on the road to recovery!

[MrPhysio+]

Hello Ambersue,
Thanks for the new information. The night pain will be occurring due to the residual inflammation and decreased movement when asleep. The balance exercises can only start once the fracture has shown good healing.
Are you trying to elevate the leg when sleeping? If not, elevation may assist at night as well as during the day.
Here's wishing you a speedy recovery.
Cheers,
MrPhysio+

[jojosephine]

Hi Ambersue,
The best way to reduce the initial pain following your ankle avulsion fracture is to reduce the amount of swelling - quickly.
The inflammatory fluid creates pressure against the damaged areas (both splinting and compressing sensory nerves causing pain) as well as containing a nerve irritant that increases in concentration the longer the area is kept still - hence increased pain at night.

You can use contrast baths to reduce swelling - Two rectangular mop buckets are needed. Partially one with luke warm water, the other two thirds full of cold water and one third with ice slush leaving enough room to avoid overflow when your foot is immersed. Put your foot into the cold bucket for 20 seconds, then the warm bucket for 20 seconds and repeat the sequence for a total of 5 times. You can do this twice a day. At other times have the leg elevated and gently move your foot backwards and forwards - the contraction relaxation of the calf acts like a pump to assist in fluid removal and gravity helps as well (ankle higher than the knee and knee higher than the hip).

If you are moving around once some swelling is reduced, a compression sleeve for ankle sprain is good, but not too tight.

Although this is a bit controversial, I prefer my patients not to take non steroidal anti inflammatories in the acute post injury stage as they can interfere with healing times and increase bleeding. The idea of a cam boot is a good one, allowing you to get around whilst supporting the ankle.

Once you have stabilisation of the fracture it is very important to start ankle balance exercises as your balance will be badly affected and if not retrained will increase your chance of further ankle injury.

Let us know how you proceed with your healing rehab.
Regards,
MrPhysio+

Useful information. I did the same when my ankle was injured. Repeated cold / hot compresses, using compression socks, and ankle balance training. Since I was no longer young, it took me a long time to get his ankle back. I still use compression stockings to keep my ankles stable.