Persistent pain after ankle sprain: targeting the causes

Most lateral ankle sprains heal with conservative treatment. Pain that lasts 6 or more weeks after a sprain may come from inadequate rehabilitation, impingement, occult osteochondral or chondral lesions, peroneal tendon or syndesmosis injury, or lateral instability. Treatment for inadequate rehabilitation includes supervised rehabilitation and home exercise. Surgery is recommended for refractory cases of impingement syndrome. Occult osteochondral or chondral lesions usually require arthroscopic excision or repair. Peroneal tendon injury should be treated conservatively before surgery is considered. The severity of syndesmosis injury determines conservative or surgical measures. Remedies for lateral instability include an ankle brace, physiotherapy, and surgery.