Broken Ankle Swelling Won’T Go Down

You’re walking along a street in New York City and suddenly, as if by magic, your left ankle swells up like someone pumped it full of water balloons. You notice that your shoe is loose on your foot and that there’s some redness around the ankle joint. But nothing compared to what happens next. Within hours — maybe even minutes — the swelling has gone from barely noticeable to so grotesquely huge that it makes you gasp for breath.
What happened? Why did this seemingly minor injury suddenly develop into an incredibly painful condition? And why does the swelling seem to be growing worse instead of going down once medical attention is sought?
The answer may lie with one of the lesser-known but no less worrisome complications of sports injuries. It turns out that when an athlete suffers a broken bone, dislocation or fracture, he also faces an increased risk of developing ankle swelling caused by inflammation. This phenomenon isn’t limited to athletes who’ve suffered a break; people who have had surgery on their knees or hips are at similar risk.
“I think most orthopedic surgeons don’t pay much attention [to] postoperative edema,” says Dr. David Mowry, an orthopedic surgeon at Henry Ford Hospital in Detroit. “But I do see patients with significant edema.” (Edema refers to excess fluid accumulation.)
Dr. Mowry notes that while he doesn’t know exactly why the problem occurs, he thinks that it could be related to how blood vessels behave after they’ve been damaged during surgery. The same might go for other kinds of trauma.
In any case, doctors recommend taking special care not only to protect the injured area against infection but also to prevent excessive swelling. Here are some tips on how to do that:
Don’t run before you walk. Broken bones need time to heal, which means you should avoid strenuous activity for at least two weeks following the accident. If you must exercise, take it easy.
Wear compression stockings. These garments help reduce swelling by compressing surrounding tissue and restricting blood flow. Doctors typically recommend wearing them for four days following knee replacement surgery or hip fracture surgery. Stockings designed specifically for use after broken ankles are available over the counter, though these aren’t approved by the U.S. Food Drug Administration because they haven’t been tested for safety and effectiveness. For more information about stocking brands, read this article from Mayo Clinic.
Get moving. Resting too long may cause muscle atrophy, leading to stiffness, weakness and pain. A good rule of thumb for reducing swelling is to move the affected part every 15 to 30 minutes. If possible, try to stand rather than sit. Walking is best.
Keep hydrated. Drink plenty of fluids to keep the wound moist and healthy. Don’t put ice packs directly on the skin. Instead, wear moisture-wicking gauze pads.
Take ibuprofen. Ibuprofen reduces swelling and provides relief from pain. However, since its effects are milder than those of stronger NSAIDs such as aspirin, talk to your doctor first to determine whether it’s right for you.
Try elevating the leg. Elevate the foot above the level of the heart. Avoid putting weight on the injured limb.
Watch for signs of infection. Signs include increasing warmth or redness at the site of the injury, tenderness or pus drainage. In addition to seeking medical treatment immediately, call a doctor if symptoms persist for more than 48 hours or worsen.
If you experience severe swelling during recovery, contact a physician. While it’s rare, sometimes the swelling can become so extreme that it causes a life-threatening increase in intracranial pressure.
One such patient was reported in 2006 in the Journal of Orthopaedic Case Reports. The man was found lying face down in his bathroom floor unable to breathe due to a buildup of cerebrospinal fluid. He’d developed a sinus infection shortly before the swelling began, causing him to lose his sense of smell and taste. He was rushed to the hospital where doctors drained nearly 1 liter of fluid from his head each hour for three days straight. Ultimately, the swelling subsided without further intervention.
While this story illustrates the worst-case scenario, it also highlights something important: When medical professionals detect problems early enough, serious complications can often be prevented. That’s especially true for broken ankles and similar injuries.
“This is one of the things we see quite frequently,” says Dr. Mowry. “We’ll see a patient come in with a swollen ankle, and we’ll say, ‘Well, we’ll give you a couple of days,’ and then within two to three days it will look like somebody hit it with a baseball bat.”

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