What is the best course of treatment for an ankle contusion with persistent swelling 10 days after injury?

Management of Ankle Contusion with Persistent Swelling

For an ankle contusion with persistent swelling 10 days after injury, the recommended treatment includes relative rest, ice application for 20-30 minutes 3-4 times daily, compression wrap for comfort (ensuring circulation is not compromised), and elevation, along with seeking medical attention for proper evaluation and treatment planning. 1

Initial Assessment and Management

• Pain and Functional Limitation: A painful ankle injury that limits use requires avoiding activities that cause pain and seeking medical attention 1
• Medical Evaluation: Since swelling persists 10 days after injury, medical evaluation is necessary to:
  • Rule out fractures or more severe ligamentous injuries
  • Assess the extent of the contusion
  • Determine if there are any complications causing persistent swelling

Treatment Protocol

1. Rest and Activity Modification

• Avoid activities that cause pain to prevent further injury 1
• Use relative rest rather than complete immobilization to prevent muscle atrophy
• Gradually return to weight-bearing activities as tolerated

2. Ice Application

• Apply cold therapy (ice wrapped in a damp cloth) for 20-30 minutes, 3-4 times daily 1
• Most effective method: ice and water mixture in a bag surrounded by a damp cloth
• Do not place ice directly on skin to prevent cold injury
• Continue ice therapy as long as swelling persists

3. Compression

• Apply a compression wrap to promote comfort 1
• Ensure compression does not compromise circulation by avoiding overtightening
• Note: While compression may provide comfort, evidence shows it may not significantly reduce swelling or improve recovery time 1

4. Elevation

• Elevate the affected ankle above heart level when possible
• This helps reduce swelling by improving venous return

5. Pain Management

• NSAIDs may be useful for short-term pain relief 1
• Consider topical NSAIDs for localized relief with fewer systemic side effects

Rehabilitation Phase

Once acute symptoms begin to improve:

• Range of Motion Exercises: Begin gentle ankle movements to prevent stiffness
• Strengthening Exercises: Start with isometric exercises, progressing to resistance exercises
• Proprioception Training: Balance exercises to improve ankle stability
• Functional Exercises: Gradually introduce activity-specific movements

When to Seek Further Medical Attention

• If swelling persists or worsens despite treatment
• If pain increases or does not improve with the above measures
• If unable to bear weight on the affected ankle
• If bruising extends beyond the ankle or appears to be spreading

Common Pitfalls to Avoid

• Returning to full activity too soon: This can lead to re-injury or prolonged recovery
• Inadequate ice application: Not applying ice properly or for sufficient duration
• Overtightening compression wraps: Can impair circulation and worsen symptoms
• Neglecting rehabilitation: Proper rehabilitation is essential for full recovery and preventing chronic issues

The persistent swelling 10 days after injury suggests that this is not resolving as expected with standard care, making medical evaluation particularly important to rule out complications or determine if additional interventions are needed 1.