Q: I sprained my ankle a few weeks ago, and although it’s much better, it still doesn’t feel quite right. Why do some ankle sprains seem to never fully heal?
A: Ankle sprains are one of those injuries that people tend to underestimate. You roll your ankle, it swells up, you limp around for a few days and, once the pain starts to improve, you figure you’re good to go. But being able to walk without much pain doesn’t necessarily mean the ankle is completely healed.
When you sprain your ankle, you injure the ligaments that help keep the ankle stable. Depending on the severity of the sprain, those ligaments can be stretched or torn. The initial pain and swelling may improve fairly quickly, but the ankle can still have weakness, stiffness or instability. The ligaments provide stability and if the ligaments are nonfunctional, then the ankle is unstable and will continue to “give out” in the future.
That’s one of the reasons people sometimes say, “My ankle just doesn’t feel right anymore.” Patients may notice that it feels weak, that it gives way, or that they’re hesitant and unstable on uneven ground. Once you’ve sprained an ankle, you’re more likely to sprain it again, especially if you don’t fully regain your strength and balance.
That’s where rehabilitation can be beneficial. The goal isn’t simply to get rid of the pain. We want to restore the ankle’s range of motion, strength, balance and stability. This is especially important for people who want to return to running or sports, where the ankle has to handle jumping, cutting and sudden changes in direction.
Another reason a sprain may not seem to heal is that it wasn’t simply an isolated sprain. Some fractures, tendon injuries or cartilage problems can cause symptoms that look like an ankle sprain at first. If you’re continuing to have significant pain or swelling, or your ankle repeatedly feels like it’s giving way, it’s worth having it evaluated.
The good news is that most ankle sprains don’t require surgery. With the right treatment and rehabilitation, many people can get back to their normal activities. Surgery is generally reserved for certain severe injuries or for people who continue to have chronic pain or instability despite appropriate nonsurgical treatment.
The biggest mistake is assuming that persistent pain or instability is something you have to live with. The damage can be progressive and eventually lead to arthritis. If an ankle sprain isn’t getting better or keeps coming back, it’s worth finding out why. The goal is to get your ankle strong and stable enough that you can trust it again and to prevent further damage.
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Dr. Jesse Doty is a foot and ankle orthopedic surgeon with Integrity Orthopedics + Sports Medicine and is a member of the Chattanooga-Hamilton County Medical Society.