bad ankle sprain

by Patricia
(galveston tx)

I sprained my ankle a week ago at work when I fell I heard a cracking noise and it rolled all the way around I thought maybe I had broke it so when I went to the ER they took xrays and said it was not broke just a severely sprained ankle with possible torn ligaments put an ace bandage on it and crutches and rushed me out the ER now a week later it has bruising all over my foot ankle and up my leg the swelling has gone down some but after kind of being able to put pressure on it it swells up really bad and I'm still having a lot of constant pain around the whole ankle bone that doesn't seem to go away is it possibly broken around the ankle bone and maybe it didn't show on the xray or is this amount of pain and swelling normal??

RESPONSE

Hi Patricia,

It is hard for me to know how much pain is normal in a given individual as I do not have the luxury of actually examining you, nor do I know anything about you, so I have nothing to compare your ankle sprain to.

Having said that, in general, most simple ankle sprains should feel at least moderately better after one week. This does not mean you are back to normal, but your pain level as well as swelling should be appreciably diminished. There should also be less pain when pressing your fingers against the ankle.

According to your narrative you actually sound like you may be worse than you were right after your accident. You do not say as much, but if you have been walking with the crutches, keeping your foot off the ground, and are still having this much pain then that too would be cause for concern.

Hearing a "cracking noise" would also raise the possibility of a broken bone. To a lesser degree it may suggest damage to an ankle ligament or perhaps to the tendon that passes underneath the outside of the ankle.

I realize you have already had an x-ray, but sometimes small breaks in the bone may not show up initially, particularly if there was a lot of swelling in the foot and ankle when the x-ray was initially taken.

So based on what I have just described, further evaluation would be required. I would recommend you make an appointment with a podiatrist or orthopedist as soon as possible. Until you have your appointment, I would suggest you stay non-weightbearing on the foot with the use of your crutches, as bearing weight with your foot will only make the pain worse.

Try and wrap your foot and ankle first thing in the morning when there is the least amount of swelling. Wrap it with moderate compression. This will help prevent the foot and ankle from further swelling during the day. Excess swelling only adds to the pain that you may be experiencing.

Chances are the doctor will take a new set of x-rays as I stated earlier, sometimes small breaks in bone do not show up initially on x-ray. If there is no break but the doctor decides that your pain is out of proportion to the extent of your injury, he or she may order an MRI.

An MRI would accomplish two things. 1. sometimes it will pick up on a fracture that is not evident on x-ray. 2. it is good at evaluating ligament tears and damage to any tendons in the area that may have been strained or even torn. Keep in mind that a severely torn ligament or tendon can be just as painful as a broken bone.

Marc Mitnick DPM
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