diagnosed sprained ankle still hurting 6 months later

by Marcie
(Lapeer, MI USA)

My now 11 year old daughter hurt her right ankle playing softball and could not put pressure on it. I took her to an urgent care where it was x-rayed and the resident said there were no breaks or fractures it was only sprained. The nurses placed her in a splint, wrapped everything and had her on crutches for a few days. That was 6 months ago! Since then I have purchased various braces and support bandages as she still complains of pain when walking, running or any other physical activity. Is this typical? I called the pediatrician and he said to send her for physical therapy. Should I take her to another doctor and see if they think she needs an MRI or at least another x-ray in case the original was flawed?

Thank you!

RESPONSE

Hi Marcie,

The nice thing about being young is children tend to heal very quickly, particularly from musculo-skeletal injuries. The fact that six months have passed and your daughter is still complaining of pain, even when just walking, certainly raises a red flag with me.

Obviously, something is still wrong. In many instances I find that patients who were not adequately treated upon the initial trauma, in many cases will have problems going forward. Based on your narrative, it sounds to me that proper care was rendered. The foot and ankle were wrapped with a compression dressing and she was put on crutches for a few days. My only objection might be that she should have been non-weightbearing longer then a few days, but that would have been predicated on how bad the ankle appeared and how much pain your daughter was in at the time and of course I was not there.

I think because six months have passed and your daughter is still in substantial pain, more information is needed as I do not think she suffered a simple ankle sprain.

The best way to see what is going on here would be with an MRI. The MRI would give a better picture of what trauma occurred at the level of the ankle ligaments, particularly whether there was a tear in any of them and how they may or may not be healing.

Additionally, there may have been a small fracture in the fibula bone, (the outside portion of the ankle) and it may not have shown up on an initial x-ray. Most importantly, the growth plate of the fibula bone is at the level of the ankle and a fracture to the growth plate can be easily missed particularly if the doctor reading the x-ray was not a radiologist or foot specialist.

Until you know exactly what is causing the pain, physical therapy seems like a waste of time. Physical therapy for injuries is best when initiated early on in an injury, not six months later.

If an MRI is performed and no pathology can be determined then physical therapy may have some value in moving things along. Along those lines, if the MRI is normal I would also want to check your daughter from a biomechanical perspective. If she has a gait where she is excessively pronated (flat footed) what that typically causes is a jamming effect on the outside of the ankle and a stretching effect on the inside of the ankle.

The jamming effect on the outside of the ankle would be something that might keep the area painful even though there is no sign of soft tissue pathology or bone fracture.

My suggestion would be to take your daughter to a foot specialist for a more thorough examination of the foot and ankle.

Marc Mitnick DPM
DISCLAIMER