Why Does My Ankle Still Hurt After A Sprain? | 4 Causes And Solutions

It can be a mind-boggling and frustrating question to ask: “Why does my ankle still hurt after a sprain?”

Turns out, you are not alone with this thought. Up to 40% of people with sprained ankles still suffer from persistent pain even after a year after their injury. (1)

This partly depends on the severity of the sprain. See, an ankle sprain heal time can be anywhere between a few weeks to a couple of months. (2)

But, there are at least 4 causes why you may still feel ankle pain even after a year after your injury. Here they are – tap on any of them to learn more:

• You developed chronic ankle instability
• Incomplete rehabilitation
• Misdiagnosed fracture
• Learned behaviors leading to persistent pain
• FAQs

1) You may have developed chronic ankle instability

Did you know that up to 55% of people with ankle sprains choose not to get medical treatment? (3) This can set back the healing potential of your ankle injury.

And an inadequately healed ankle can progress into a condition called chronic ankle instability (CAI). (4)

Some of the characteristics of CAI include persistent pain, repeated ankle sprains, and unsteadiness.

These symptoms can come from two things. Either your lateral ankle ligaments became too loose, or you have impaired ankle sense and strength. (5)

Solution: Get your sprained ankle checked by a medical doctor

A combination of a physical exam and diagnostic tests will help your doctor determine the extent of your injury. He/she will also advise you on the proper treatment plan for your condition.

Some conservative treatments like physical therapy can help set your injured ankle on the right course of recovery. But if your injury is too severe, your physician may refer you to a foot and ankle surgeon.

Further reading: The 5 right things to do after you sprain your ankle

2) Dropping out too soon from physical therapy

If you feel like your therapist has failed you or PT just isn’t worth the effort, then I completely get what you’re saying. 

But, as a physical therapist and an occasional patient myself, I tell you – you have to trust that your therapist is doing what’s best for you. 

Not all ankle injuries heal equally. And honestly, not everyone responds the same way to PT. It may take some trial and error to find the best combination of treatments for you.

But that’s what your physio is for – to guide you through that process. Rehabilitation not only provides pain relief, but also bulletproofs your ankle joints from future sprains.

Keep reading: What does physical therapy for ankle sprain look like?

Solution: Finish your physical therapy program

Fixing chronic pain from your injured ankle joint can be challenging, but certainly not impossible.

Now, if you aren’t satisfied with your prior PT experience, you can always try a different clinic. Each therapist has a unique style and treatment approach.

So, please go back to rehab – whether with your previous therapist or a new one – to set you on your road to recovery.

Pro tip: A quick way to know if you’re in good hands is if your PT checks in with you, wanting to know if their treatment is helping or not. Rehabilitation is a two-way street and good communication is key.

3) You might have a misdiagnosed ankle fracture

In some cases, what you may shrug off as “just a sprain” or a sore ankle might be an ankle fracture.

Due to the similarities in symptoms, some subtle ankle fractures can mask off as a sprain. (6)

This can be alarming. Without proper treatment, it can lead to either a malunion or nonunion bone formation, causing a huge delay in your recovery.

A malunion is when a broken bone has healed but did so in an abnormal position. On the other hand, a fracture that is unable to heal itself is classified as a nonunion of bone.

This will help: Differences between a broken ankle vs an ankle sprain

Solution: Go to a foot and ankle specialist

In this case, getting in touch with a specialist (like a foot and ankle surgeon) should be your top priority. They might request an X-ray or MRI to get a better look at your affected foot.

In the case of a malunion fracture, you might need ankle surgery to realign the broken bone.

But if it’s nonunion, you may need to immobilize your ankle with a walking boot for some time. If this treatment fails, the specialist may perform other treatments like ultrasound or bone stimulation. (7)

4) Your chronic pain came from learned behaviors

In this case, your ankle ligaments may be completely healed. But due to fear or anxiety, you may get used to thinking that moving your ankle will only lead to more pain.

This is a learned behavior that comes from your brain and nervous system. (8) I know this can be hard to wrap your head around, so let’s start with the basics:

Pain is a natural warning signal from your brain.

See, pain is an unpleasant sensation by design. In a fresh injury, it changes the way you move. This is to avoid worsening the sprain and letting it heal properly.

But this same pain can make you fear moving your ankle. You might feel anxious by the thought of using it.

Over time, as you reinforce this fearful behavior, your brain learns that moving your ankle is dangerous, thus keeping this pain for longer. This is known as a learned behavior. (8)

So, this mentality of “avoiding ankle pain at all costs” can actually be the culprit that keeps the pain for longer.

Solution: Step out of your comfort zone

One incredible thing about the brain is that it adapts quickly to anything. What is “learned” can also be “unlearned”.

When it comes to chronic pain, you can “unlearn” it. This should be done under the supervision of a therapist specialized in this type of pain, though.

There are physical therapists specialized in treating this. They gradually increase your activity tolerance until you are back to your previous self.

Another approach is cognitive-behavioral therapy (CBT). This is a type of psychotherapy that’s effective for those with chronic pain. (9) It helps unlearn thoughts and behaviors, replacing them with more healthy and actionable habits.

FAQs

Conclusion: Why does my ankle sprain still hurt?

Like most ankle injuries, ankle sprains are often brushed aside for bigger issues in our daily lives. Only when it keeps on nagging for some time will most people try to seek treatment.

So if you’ve been experiencing ankle pain for months or years, don’t lose hope! There are still actionable solutions to your problem.

Resources

1. American Academy of Orthopaedic Surgeons. “Chronic Ankle Pain May Be More Than Just A Sprain.” ScienceDaily. ScienceDaily, 11 May 2009. https://www.sciencedaily.com/releases/2009/05/090501090931.htm
2. Hubbard, Tricia J, and Charlie A Hicks-Little. “Ankle ligament healing after an acute ankle sprain: an evidence-based approach.” Journal of athletic training vol. 43,5 (2008): 523-9. DOI: 10.4085/1062-6050-43.5.523
3. Adal, Saeed Al et al. “The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study.” Journal of sport and health science vol. 9,1 (2020): 96-101. DOI: 10.1016/j.jshs.2019.07.009
4. “Chronic Ankle Instability“. American College of Foot and Ankle Surgeons. Accessed 23 February 2022. https://www.acfas.org/footankleinfo/chronic-ankle-instability.htm
5. Al-Mohrej, Omar A, and Nader S Al-Kenani. “Chronic ankle instability: Current perspectives.” Avicenna journal of medicine vol. 6,4 (2016): 103-108. DOI: 10.4103/2231-0770.191446
6. Judd, Daniel M.D. et al. “Foot Fractures Frequently Misdiagnosed As Ankle Sprains”. Am Fam Physician. 2002 Sep 1;66(5):785-795. https://www.aafp.org/afp/2002/0901/p785.html
7. Thomas JD, Kehoe JL. Bone Nonunion. [Updated 2021 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554385/
8. Cosio, David, Ph.D., ABPP. “The Perseverance Loop: The Psychology of Pain and Factors in Pain Perception”. Practical Pain Management. Volume 20, Issue #1, Pages 19-22. https://www.practicalpainmanagement.com/treatments/psychological/perseverance-loop-psychology-pain-factors-pain-perception
9. Lim, Jae-A et al. “Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy.” Medicine vol. 97,23 (2018): e10867. DOI: 10.1097/MD.0000000000010867