Is a constant burning sensation normal in a sprained ankle?

Constant Burning Sensation in a Sprained Ankle

A constant burning sensation is not normal for a typical ankle sprain and warrants medical evaluation to rule out nerve involvement or other complications.

Normal vs. Abnormal Pain Patterns in Ankle Sprains

Ankle sprains typically present with:

• Sharp, localized pain that improves over days to weeks
• Pain that worsens with movement and weight-bearing
• Gradual improvement with proper treatment and time 1

A constant burning sensation, especially one that persists without improvement, suggests:

• Possible nerve involvement
• Potential development of complex regional pain syndrome (CRPS)
• Inadequate treatment or complications of the initial injury 2

Possible Causes of Burning Pain

1. Nerve Involvement

• Direct injury to peripheral nerves during the sprain
• Compression of nerves due to swelling
• Nerve irritation from inflammation 2

2. Complex Pain Syndromes

• Complex regional pain syndrome (formerly known as reflex sympathetic dystrophy)
• Erythromelalgia (rare condition characterized by burning pain and redness) 2

3. Inadequate Treatment

• Incomplete rehabilitation is the most common cause of chronic pain after ankle sprains 3
• Continued inflammation due to premature return to activities 1

When to Seek Medical Attention

Seek immediate medical evaluation if:

• Burning pain is constant and not improving
• Pain is accompanied by redness, warmth, or color changes in the foot
• Pain is disproportionate to the injury
• Numbness or tingling is present
• Pain persists beyond expected healing time (2-6 weeks depending on severity) 1

Diagnostic Approach

Your healthcare provider should:

• Perform a detailed physical examination, optimally 4-5 days after injury when swelling has decreased 1
• Assess for signs of nerve compression or irritation
• Consider imaging if symptoms persist or are severe
• Rule out fractures using Ottawa Ankle Rules if not already done 1

Treatment Considerations

For Typical Ankle Sprains:

• PRICE protocol (Protection, Rest, Ice, Compression, Elevation)
• NSAIDs for pain and inflammation (with caution as they may suppress natural healing) 1
• Functional rehabilitation with supervised exercise program 1
• Semirigid supports or braces rather than elastic bandages 1

For Burning Pain:

• Further evaluation for nerve involvement
• Consider referral to pain specialist or neurologist if burning persists
• Medication specifically targeting neuropathic pain may be needed
• Physical therapy focusing on nerve mobilization techniques 2

Prevention of Chronic Pain

• Complete appropriate rehabilitation before returning to full activities
• Use proper ankle supports, especially with history of previous sprains
• Incorporate proprioceptive training (ankle disk exercises) 1

Common Pitfalls to Avoid

• Dismissing persistent burning pain as normal
• Inadequate rehabilitation before returning to activities
• Failing to recognize potential nerve involvement or CRPS
• Excessive immobilization without appropriate functional exercises 4

Remember that 20-40% of patients may develop chronic pain after ankle sprains 3, making it crucial to address persistent burning sensations promptly rather than dismissing them as a normal part of the healing process.