What is the typical duration of pain after an ankle sprain?

Duration of Pain After Ankle Sprain

Pain from an ankle sprain typically decreases rapidly in the first 2 weeks after injury, but 5-33% of patients may still experience pain and instability symptoms after 1 year. 1

Timeline of Pain Resolution

Acute Phase (0-2 weeks)

• Pain is most severe in the first 48-72 hours after injury
• Significant improvement typically occurs within the first 2 weeks 1
• Excessive swelling and pain can limit examination up to 48 hours after injury 1

Subacute Phase (2-6 weeks)

• Most patients with mild to moderate sprains (grade I-II) experience substantial pain reduction
• Ability to walk again within 48 hours after trauma indicates a good prognosis 1
• Functional treatment leads to faster return to work and sports compared to immobilization 1

Chronic Phase (>6 weeks)

• According to the most recent evidence, 6.7% of patients still report residual pain at 12 months following a first-time lateral ankle sprain 2
• The occurrence of patients with subjective instability decreases from 37.9% at 3 months to 8.1% at 12 months 2
• Recurrent sprains occur in approximately 15.8% of patients within 12 months 2

Factors Affecting Pain Duration

Severity of Injury

• Grade I (mild): Minimal pain and swelling, typically resolves within 1-3 weeks
• Grade II (moderate): Partial ligament tears with moderate pain, typically resolves within 3-6 weeks
• Grade III (severe): Complete ligament rupture with severe pain, may take 6-12 weeks or longer to resolve 1

Risk Factors for Prolonged Pain

• High level of pain at initial presentation 1
• High-level sports participation 1
• Inadequate rehabilitation 3
• Reinjury of the ankle (increases odds of moderate to severe residual symptoms by 7.21 times) 4
• Activity restriction longer than 1 week 4
• Limited weight bearing longer than 28 days 4

Warning Signs of Complications

• Constant burning pain that does not improve with time 5
• Pain accompanied by redness, warmth, or color changes in the foot 5
• Pain disproportionate to the injury 5
• Numbness or tingling 5
• Pain persisting beyond expected healing time (2-6 weeks depending on severity) 5

Treatment Considerations to Reduce Pain Duration

Immediate Management (PRICE Protocol)

• Protection
• Rest (limited to 72 hours) 1
• Ice (cryotherapy) 1
• Compression 1
• Elevation 1

Medication

• NSAIDs have been shown to improve pain control, decrease swelling, and allow more rapid return to activity compared to placebo 1

Rehabilitation

• Functional treatment is superior to immobilization for ankle sprains 1
• Exercise therapy helps prevent recurrence 1
• Proper rehabilitation before returning to full activities is essential to prevent prolonged pain 5

Common Pitfalls and Caveats

1. Overlooking fractures: Always use the Ottawa Ankle Rules to exclude fractures in the acute setting 1

2. Prolonged immobilization: Extended immobilization can lead to longer recovery times; functional treatment shows better outcomes 1

3. Inadequate rehabilitation: This is a common cause of persistent pain beyond 6 weeks 3

4. Ignoring persistent symptoms: Pain that persists beyond 6 weeks may indicate complications such as:

   • Impingement
   • Occult osteochondral lesions
   • Peroneal tendon injury
   • Syndesmosis injury
   • Lateral instability 3

5. Premature return to activity: Returning to sports or full activities before adequate healing can lead to reinjury and prolonged symptoms 5