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Sports Medicine

Sprained ankle

08/17/2009

Question:

I sprained my ankle about 2 weeks ago, at least I think it`s sprained, and I feel much better since, however my ankle is still swollen. Is this normal or should I seek immediate professional help? I don`t have much pain and almost full movement of my ankle, but it`s been 2 weeks already and I`m a little concerned. Most of the pain comes when I move my foot left to right, but not up and down. Is the swelling normal or should I go visit my doctor as soon as possible? If it`s normal, is there something I can do to get the swelling down? I read online to soak my foot in ice water for 15 to 20 minutes then wait 20 minutes and repeat again. Is this a good way? Thank you for the help

Answer:

Persisting swelling following an ankle sprain may occur if the person hasn't been elevating and/or applying ice to and/or compressing the injured region of their ankle.

Particularly relevant to the treatment of ankle sprains is the mnemonic (memory aid):

Protection by avoiding/minimizing activities and situations which 
could result in re-injury, and possibly wearing an ankle-stabilizing brace if there's ankle pain, weakness and/or joint laxity/instability.

Relative - rather than absolute - rest, meaning being as active as symptoms permit, particularly including low-impact or no-impact cross-training activities to regain or maintain aerobic fitness.

Ice application for 15-20 mins., particularly useful during the first 24 hours after injury to reduce the degree of swelling which may otherwise occur, although unfortunately, ice isn't expected to reduce swelling which is already present (but pain/inflammation reduction can still certainly be achieved with ice application more than 24 hours post-injury).

Compression, as can be provided by using an elastic bandage - preferably in conjunction with also utilizing a U-shaped piece of padding placed beneath the injured ankle, vs. compression via a pneumatic ankle brace (Aircast and others).

Elevation as much as possible - ideally at or above the level of the heart... prolonged periods of sitting on a chair with the foot on the floor beneath you would be the worst scenario.

Rehabilitation, including relevant strengthening and flexibility exercises, and in particular, balance and agility retraining.

Although unlikely in your case since you've already improved considerably, another possible cause for persisting swelling is injury to a cartilage surface within your ankle, and/or to one or more ligaments (which hold bones together).

If you fail to continue to improve, or to clarify your diagnosis and the most appropriate treatment plan for you, consider consulting with your primary care physician or a sports medicine physician.

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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