Chronic Ankle pain possibly due to an unresolved severe sprain 3 years ago.

Dear Ask The Doctor: I had a fairly severe right ankle sprain 3 years ago. I had a little bit of physical therapy in the ensuing weeks, but eventually kind of gave up on that because I didn't have time. The ankle has continued to give me problems for 3 years (I was unable to jog for 5 or 6 months, and then I have had pain and stiffness intermittently during exercise or normal daily activities) The ankle is also much larger (scar tissue?) than the left ankle. Probably twice as big at least. The ankle seems structurally ok to me, maybe still a little weak, but I have pain on both sides of the ankle. When I rotate my foot there is a popping or clicking sound that doesn't hurt, but makes me wonder if something didn't heal properly. At this point I would just like to know if there are any options for recovery (therapy, surgery) or if it is just something I will need to manage. I have put on weight since exercising is difficult, and I'm sure that isn't helping things. P.S. I didn't go to a specialist because I didn't have insurance at the time... I would just like some more info before I go get a bunch of tests and pay money to a doctor now. Thanks. The photo that looks like the left foot is actually the right foot and vice-versa.

Dear David: 

According to your description and the images that you provided, you might be experiencing a Chronic ankle pain due to a unresolved severe ankle sprain, meaning that by the time when you twisted your ankle, three years ago, maybe you had lack of appropriate and early immobilization, lack of timely prescribed mobility and strengthening exercises, the development of scar tissue in the ligaments affected, or too much time immobilized. All these mentioned factors are cause of Chronic Ankle pain and instability. Sometimes the use of orthotics that correct the Hyperpronation of the ankle (ankle with tendency to be inwards) is useful in relieving the symptoms (pain and inflammation) in the chronic and unresolved ankle sprains. If this does not work, further evaluation, meaning local exam in terms of checking ankle stability and imaging, MRI, to see integrity of the ligaments are required to determine the right treatment option. If there are no ligamentous tears, you could still use some physical therapy treatment sessions to control pain and swelling that include: ultrasound, whirpool baths, ice and heat and active exercises to strengthening the ankle muscles, it helps also tape the ankle and begin the weight bearing progressively, as long as you do not feel pain or discomfort. But if there are ligamentous tears seen in the MRI and mayor ankle instability, then the surgery may be considered.