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Athletic Training

Why Does My Sprained Ankle Keep Swelling?

08/15/2000

Question:

I sprained my ankle about a week ago. I can walk on it and it’s not very painful. I wrap it with an ace bandage and swelling will go down, but when I take off the bandage and walk around it normally swells up again. I’ve tried ice packs, elevation, and epsom salts. I wrapped it back up for now, but I was told by a friend that it will continue to swell if I keep it wrapped. What to do? Why does it go down then keep swelling back up?

Answer:

Ankle sprains are one of the most common and most frustrating injuries that we see in our athletes. A sprain itself is damage to one or more ligaments that surround the ankle joint. There are 3 main types of ankle sprains: lateral, medial and syndesmotic (or a "high" ankle sprain).

The lateral ankle sprain is most common and involves 1, 2 or all 3 of the ligaments which support the outside part of the ankle. Medial ankle sprains involve the larger group of 4 ligaments in the inside aspect of the ankle. "High" ankle sprains involve 1 or 2 ligaments which hold the two bones in the lower leg together. Usually this occurrs when the foot is planted and the body twists, often occurring if the activity is on a poor playing field with many "potholes".

We usually classify ankle sprain as mild (1-4 weeks until normal), moderate (4-8 weeks) or severe (8 weeks plus). The best treatment follows the RICE Principle (Rest, Ice, Compression Elevation). If the athlete cannot walk normally, we will crutch them (Rest).

Ice should be applied for 15-20 minutes (on both the inside AND outside of the ankle) several times a day (Ice). I often recommend an "ice bucket". Take a small trashcan, fill bottom layer with ice, fill half way with water and soak entire ankle joint for 10 minutes. Take 20 minutes off and repeat soak for 10 more minutes.

A compressive ace wrap should be applied starting below the injury and rolled up (this pushes the swelling towards the heart) and should not have any gaps or skin showing (even cover the heel) in order to be most effective (Compression).I recommend wearing this at all times, even when sleeping and at work. Be wary that you may apply the wrap too tightly: watch for a "blue" foot, numbness and tingling. If this occurs, undo the wrap and reapply with more slack.

Finally, the ankle should be evelated above the heart to prevent recurrent swelling (Elevation). If this treatment is followed for 1 week and there is minimal improvement, I would recommend that you see a physician who will most likely order an x-ray to make sure that you are dealing with a ligament injury versus a possible bone injury.

Often times it can take the full 4 -6 weeks to feel "normal" even after a mild ankle sprain. Once the swelling is gone and motion is restored, you should perform some ankle strengthening and balance exercises before returning to full activity. I would contact a local sports medicine clinic to have some initial formal instruction, but most of this rehab can easily be done at home.

Additionally, we recommend a lace-up ankle brace to provide extra stability during the first few months of activity after such an injury. Most pharmacies or your local sports medicine clinic can present you with several choice of braces to use. Good luck!

Related Resources:

Tips for Treatment of Athletic Injuries

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Response by:

Vincent J O'Brien, ATC Vincent J O'Brien, ATC
Head Athletic Trainer
Clinical Instructor at the School of Allied Medical Professions
College of Medicine
The Ohio State University