Why does an ankle sprain take so long to heal?

This is the 2662nd article of Da Yi Xiao Hu

In the outpatient clinic, we often encounter many patients with ankle sprains that "do not heal for a long time". The swelling has not subsided for a long time, and there are various discomfort complaints when walking or exercising. What is going on? Have you or your patients ever experienced a similar "situation"?

These patients did not delay diagnosis and treatment. They came to the hospital in time after the sprain and had an X-ray examination to rule out fractures. They followed the emergency doctor's instructions to apply ice, elevate the affected limb and rest. However, the situation was not as the emergency doctor said that it would be fine in a few days. Instead, there was still swelling and slight pain after a few weeks, and obvious discomfort when walking for a long time. Let me answer your questions below.

The foot is the most active part of our body. The ankle joint is an important link between the foot and the body trunk, so there are many blood vessels, nerves, tendons and ligaments around the ankle joint that are responsible for the blood supply, sensation and movement of the foot. These structures cannot be shown on X-rays, but they are the key to the problem. How to further check these important structures? I believe many friends already know the answer, that is, magnetic resonance imaging (MRI).

The upper left picture is an ankle X-ray taken when we visited the emergency room, and the right picture is an MRI of our ankle, which allows us to see all the structures around the ankle clearly.

Since there are many important ligaments around our ankle joints to maintain the stability of our feet during high-intensity exercise, there is a high possibility of these ligaments being damaged when the ankle joint is severely sprained. As shown in the diagram below:

These injuries cannot be shown on emergency X-rays, but they should be treated promptly. So as an experienced orthopedic surgeon, I would like to remind you that if there is no significant improvement after one week, you should immediately make an appointment for an MRI (usually takes about 2 weeks). During this period, you should use an ankle brace to limit the movement of the ankle joint to avoid further aggravation of the injury.

Most ligament injuries can be treated conservatively in the early stages. However, if you do not fix them in time or continue to "over-move", the torn ligaments will become more and more serious, and eventually become completely broken (i.e., the third-level injury in the figure below) and unable to repair themselves. In this case, as described at the beginning of the article, the swelling will not subside for a long time, and there will be obvious discomfort after walking or exercising for a long time, and there will even be obvious joint instability. This situation often requires surgical ligament reconstruction to repair.

Ankle sprain is one of the most common diseases in our orthopedics, but its treatment is not as simple as "apply ice and rest for a few days" as many people think. I hope that after reading this article, you can have a deeper understanding of ankle sprains and forward this article to friends around you who need it. Let them get timely and correct treatment, recover soon, and not leave regrets for their feet.

Author: Shanghai Seventh People's Hospital

Department of Traumatology and Joint Surgery, Ju Yufeng