Why is my ankle injury not healing

Most ankle injuries are sprains that are one of the most common injuries presented to the A&E department in the UK. Approximately 1000 sprains a day are reported across the country and that figure increases during weekends with local sporting events.

In this article, Mr Stefan Weitzel, one of our top consultant orthopaedic surgeons, explains exactly what to do if you sprain your ankle and what actions you should take if you don’t start to notice any improvement after a couple of weeks.

How long does a typical ankle sprain take to heal?

The time it takes for an ankle sprain to heal depends on its severity. Most are mild to moderate partial ligament injuries that can be self-managed and will typically heal within 2-4 weeks. If, however, you cannot bear weight or stand on the ankle after the injury, you ought to seek medical attention at an urgent care centre or with your doctor fairly quickly as it may indicate something more serious. Many of these turn out to be more severe ligament injuries that can take 6-8 weeks or longer to settle and may benefit from additional treatment.

What treatments are recommended for mild ankle sprains?

The main aim of treatment is to reduce pain and swelling and promote healing. Mild ankle sprains can be self-managed, and you should employ the RICE approach for the first few days:

Rest — try to avoid activities that cause your ankle pain or discomfort

Ice — Apply ice to the affected area immediately after a sprain for at least 15 minutes. You can keep applying this every two to three hours to relieve pain.

Compression — You can use a bandage or stocking to compress the swelling. You should do this until the swelling has reduced. Try to not to wrap the ankle too tightly as this can inhibit proper blood circulation.

Elevation — elevating your ankle to hip level or above can help reduce swelling. You can use this technique at night while you sleep.

If you find it difficult to walk, you may find the use of crutches helps. Generally, it is better to move about as much as possible. In the past, patients were advised to bed rest, which now has been proven to be wrong - gentle movement and early mobilization are required to help heal soft tissues. You should usually expect your ankle to improve after one week with pain & bruising improving first and swelling lagging behind a little dependent on your activity level.

When is an ankle sprain more serious?

When you notice an absence of progress after 3-4 weeks this could indicate a further problem with your ankle. If, for example, you notice widespread bruising all around the ankle or see the bruise going down the foot, then it can suggest there is something more serious going on. Therefore, you should see your GP and they may refer you on to see a specialist like myself, who will assess you and arrange imaging such as X-rays or even an MRI scan.

What are some reasons ankle sprains don’t heal on their own?

There are many reasons why your ankle sprain is not healing as expected. This could be from:

• Fractures that have not been recognized
• Bone bruising or internal bone fractures that do not show on X-rays
• Ligament injuries with complete disruption rather than partial tears possibly leading to impingement pain or instability
• Cartilage damage
• Damage to tendons on the inside or outside of the ankle
• Achilles tendon injuries that were missed

What should you do if your ankle does not improve?

As mentioned before, you should seek medical attention either from your GP to refer you on to see an orthopaedic surgeon who specialises in treating foot and ankle injuries. Further clinical assessment and scanning may be needed to establish exactly what the pathology is in the ankle. This may include:

• MRI scan
• CT scan
• Ultrasound

From there, the treatment depends on the type of injury. Fractures, severe ligament and tendon injuries may need prolonged immobilization or splintage. Often intensive early physiotherapy and rehabilitation can help to relieve stiffness, build strength in the ankle and speed up the recovery. More rarely, fractures and cartilage and tendon injuries such as Achilles ruptures may benefit from early surgery (less than 5% of soft tissue ankle injuries eventually require surgery).

If you have injured or sprained your ankle and you are worried about it, book a consultation with Mr Stefan Weitzel by visiting his Top Doctors profile and checking his availability.