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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 65641
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I endured a severe sprain to my ankle nearly eight weeks ago.

Resolved Question:

I endured a severe sprain to my ankle nearly eight weeks ago. I raised it and plunged it into cold water every two hours for ten minutes. It swelled badly. After a week blue bruising appeared along the ankle side of the foot and by the heel and yellow bruising along the top of the foot towards the toes. I went to hospital and had three x rays. There was no bones broken. They strapped the foot forcing my toes towards my leg and told me to keep it on for three days and to keep off the foot for a further two weeks. Three weeks later it was still very tender and sore so I kept off it. At the beginning of the fourth week I started light massage with arnica oil and hydrotherapy putting the air and water jests on in the bath. The swelling reduced considerably by now and the bruising by the heel was only just about visible. I went to the doctors on the sixth week anniversary and asked if I could put weight onto the ankle bearing in mind that I had been doing exercises for over a week to strengthen the muscles. He examined the foot and and assessed the movement and whether I could feel someone touching the bottom of my foot and he said I could stand on it. The first time I experienced severe tingling and after five seconds I had to sit down because I thought I was going to be sick. I continued to do exercises and the tinging abated. I then manged to stand on my foot for forty minutes just moving the foot slightly but only bearing about 80% weight onto it. I did this twice a day. After 52 days I was brave enough to bear full weight and I was quite surprised that I manged it without feeling any pain. I think I might have overdone it because I found that I could go up steps without any pain either. That night my foot swelled considerably right up to the knee. I have kept off it just in case I have undone all the hard work i have put in over the last eight weeks. I am lying down with my foot raised hoping that in time this severe swelling will go completely. Can you give me any advice please? It was stiff this morning and so I thought I had better not bear any weight on it today but I know I shall experience stiffness over a period of time. It has swollen again today even though I have not walked on it.
Submitted: 2 years ago.
Category: Medical
Expert:  DrRussMD replied 2 years ago.
Hello
Go get an ultrasound of the leg immediately.
This can be a blood clot that has formed and will need immediate treatment./
OK, so that is an initial answer….
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Customer: replied 2 years ago.

The swelling abated over night and the leg was back to normal this morning. It is only when I am up that it swells. I must admit I am surprised that it swells so badly and swells as far as my knee. I have it raised now and it is still swollen after three hours of having it raised. Do you still think that it may be a blood clot, More importantly why has the blood clot formed?

Expert:  DrRussMD replied 2 years ago.
It can happen after injury.
It is unlikely the swelling would go down and up , up and down with a blood clot.
Another possibility is inflammation itself. Aggravated while you are up.
Still needs exam.
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Customer: replied 2 years ago.

What could cause excessive inflammation? This started last evening when I had been on the foot for sometime and the first time in nearly eight weeks?

Expert:  DrRussMD replied 2 years ago.
strain on already damaged tendons and ligaments.
The only way to actually see this is with MRI scan.
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Customer: replied 2 years ago.

I am assuming that because it was a severe sprain that the tendons and things were damaged hence the bruising. I am on holiday at the moment so it makes life difficult. Should it swell as far as the knee? That is what has surprised me considerably. This morning it was back to normal. So to clarify if it was a clot would it do that, in other words go back to a normal position? I am just worried that after four hours of having it raised it has not gone down but it is not as swollen as last night, having said that I haven't been on it today at all.

Expert:  DrRussMD replied 2 years ago.
It should not swell as far as the knee in most cases.
Bad veins in the leg itself is a common reason this happens, and injury makes it worse.
Typically, this would get better staying off the leg.
Ultrasound confirms this.
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Customer: replied 2 years ago.

I am going to raise my foot above the heart and see what happens. if it subsides in the next couple of hours then we know it is due to the injury of the tendons. Keeping off it hopefully will substantiate this. You still think I should get it checked out as it has swollen so badly? The reason I am trying to make sure is that the doctor was surprised that I had stayed off it for six weeks, but having said that it was still tender after four weeks. I don't think he realised how bad the initial injury was even though I showed him the pictures.

Expert:  DrRussMD replied 2 years ago.
It can also be due to injury of the veins.
I still say you should be examined.
I would also start with an ultrasound.
That recommendation is not going to change.
A sprain can take 3 months to heal.
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Customer: replied 2 years ago.

If there is damage to the veins will these repair in time?

Expert:  DrRussMD replied 2 years ago.
It can be improved, often not cleared up all the way.
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