OpenHealth Q&A

Persistent Pain and Swelling in Sprained Ankle After Four Weeks

About four weeks ago, I endured a sprain to my right ankle when a rotting wooden step gave way beneath me, causing me to fall directly down and then roll to my left side. I am a middle-aged woman experiencing menopause, standing 5'8" and weighing 145 pounds, with no significant health issues and not a smoker. The emergency room doctor indicated there was no fracture evident on the x-ray. Initially, I experienced intense pain that resulted in sleepless nights, despite propping my ankle with several pillows. As a precaution, I refrained from putting any weight on it for the first two days. By the fourth day, my entire foot, the ankle area, and part of my lower leg were noticeably bruised, with significant swelling. While it was sore, I was able to bear some weight, although painful. An orthopedic specialist examined me and suggested it was likely a grade 2 sprain, expressing doubts it was a grade 3. He recommended walking as much as I could for mobility, discontinuing the use of a brace or air cast, continuously applying ice and keeping it elevated regularly, and provided some physical therapy exercises along with resistance bands. One week into the injury, I was managing to get around, though the pain was consistent, and attempted to drive. However, pressing the gas pedal elicited such sharp discomfort that I had to engage the parking brake and exit the vehicle in haste—despite not even shifting it into park! This sudden jolt felt like a fresh injury. I reached out to the orthopedic office, and they advised: 1) to avoid weight-bearing for another week, 2) a potential bone injury was noted at the tip of the tibia in the x-ray, and 3) to initiate the physical therapy exercises in the second week. Now, at the four-week mark, my ankle is still sensitive to touch and painful if moved incorrectly, and it tends to swell slightly if I've been on it for more than 5 to 10 minutes, such as during a 20-minute grocery shopping trip. Although I’m trying to keep up with the suggested exercises, the ankle feels unusually stiff. There’s still a notable restriction in my range of motion, preventing me from walking the dog or attending sports with the children. However, I am managing routine household tasks like mopping, vacuuming, washing dishes, and doing laundry. Driving short distances is possible, but it makes my ankle sore. Financially, I am unable to afford an MRI or surgery at this time as I’m between jobs and lack insurance, although I could possibly put it on a credit card if absolutely necessary. I'd prefer not to spend $400 just to visit the orthopedic again, only to be told to have patience. Is this kind of persistent pain and swelling typical after four weeks? From what I’ve seen online, many people seem to be back to running and gym activities within 5-6 weeks post severe sprains, which feels far from my reality. Should I wait a few more weeks to see if my condition improves, or is it imperative that I consider getting an MRI? Additionally, would walking more help loosen the stiffness even if it risks more swelling and pain?

Answers (1)

8/27/2025, 1:04:22 PM

OpenHealth AI

It’s understandable to be concerned about persistent pain and swelling after a sprained ankle, especially since it has been four weeks since your injury. While some people may recover more quickly, each injury and person is different. Here’s what you need to know:

Main Points:

1. Ongoing pain and swelling can be common after a moderate to severe sprain.
2. It's important to balance rest and gentle movement to promote healing.
3. Consider monitoring symptoms for another week, but don't hesitate to seek further evaluation if conditions worsen.

Explanation:

A sprained ankle involves injury to the ligaments that stabilize the joint. Grade 2 sprains can take several weeks to heal, and persistent symptoms like pain, swelling, and stiffness are not unusual after four weeks, especially if you've had a secondary injury or if the swelling has not fully resolved.

The sensation of stiffness and pain when moving your ankle is typical as well. The goal is to gradually restore range of motion without overexerting the area, which may lead to more swelling or pain if aggravated.

Next Steps:

1. Continue Rehabilitation Exercises:

   • Focus on the physical therapy exercises provided by your specialist to improve strength and flexibility. Gentle stretching can also be beneficial.
   • If something feels too painful, modify the intensity or range of motion of the exercise.

2. Monitor Activity Levels:

   • For walking, try to increase the duration gradually but pay attention to how your ankle responds. If swelling increases significantly, it's a sign to rest it more.
   • Aim for short walks initially, and increase duration as tolerated.

3. Apply RICE:

   • Continue using Rest, Ice, Compression, and Elevation (RICE) regularly, especially after activities that cause swelling. Ice should be applied for 15-20 minutes multiple times a day.

4. Assess Pain Management:

   • Now might be a good time to consider over-the-counter anti-inflammatory medications like ibuprofen or naproxen (if safe for you) to help with swelling and pain.

5. Keep a Symptom Diary:

   • Track your pain levels and any activities that exacerbate your symptoms. This log can help you make informed decisions about your activity level and identify patterns.

6. Consider Seeking Further Evaluation:

   • Given the ongoing pain and your concern about potential bone injury, if symptoms do not improve or worsen (like increased pain, swelling, or difficulty bearing weight), it may be worth investing in an MRI, even if it requires using a credit card.

If after one more week you see no improvement in your condition, or if the pain and swelling worsen significantly, weighing the cost of further evaluation may be necessary for your peace of mind and recovery.

Feel free to reach out if you have further questions or updates about your recovery!