Ankle sprain or fracture? (And how to treat)

Patient

Q: Before hiking, I felt a slight painless kink on the front of my right ankle so I stretched it briefly and thought nothing of it. I hiked for 3 hours and was fine. The next morning I woke up with ankle pain and limped/rested that day. The next day I had no pain, and hiked for 2 hours with no pain at all. That night I woke up with ankle pain. I used a hot tub that day, which was a bad choice, I know. Now it's the third day in a row of recurring pain. When I'm not on ibuprofen I feel increasing pain. I cannot bend my ankle or walk. The pain is mostly on the inside of my ankle. What do you think I need to do other than rest and ice it?

Symptoms:  Strained/sprained ankle
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

This is definitely a ligament stretch injury which you have suffered during hiking and more likely to be the Anterior talofibular ligament (ATFL). The ideal form of treatment is definitely cold compresses and rest but as you are hiking already then i should suggest a ankle splint which can restrict your lateral movements especially when you are walking on road or stony ground. We really can't stop the flexion and extension movement and hence during walking when the endorphin levels are high and you are on ibuprofen, the pain is not felt but as the effect wears off , the pain reappears.

I feel you should continue on your NSAID and complete your hike, just watch for excessive swelling and redness if at all, as that would be a sign that you need to end your hike and return for rest.

I hope i have answered your query,
Wishing you safe hiking,
Regards

Comments / Follow Ups

Patient: Thank you. I'm done hiking (and cannot even walk anyway) so will only rest and ice and also wrap my ankle when I must jump around. But I must travel home tomorrow so will be jumping on the opposite leg and only using my foot when absolutely necessary. Do you have any advice for me as I travel? How long until I should be healed? Is it normal to be in this much pain? I admit I am usually not hurt, so I feel more pain than others perhaps! Thank you.
Doctor: Actually you have aggravated your injury by ignoring the rest part from day 1 and went on with hiking. Now as the pain is excruciating without pain killers, it indicates that you may have even experienced a stress fracture even, one may not know until an X-ray is performed. If its a sprain and not a fracture then it should heal in a week but if its a fracture then it shall take 4-6 weeks ideally. You have to be on a stick support while walking back home to avoid as much less strain over your injured foot.
Final assessment of injury can be made at the hospital, which you would need to visit anyhow.
Regards

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