A stubborn ankle that stays swollen, painful or unstable weeks after a sprain may signal an ankle ligament tear. Dr Tan Ken Jin explains how these hidden injuries develop and why early assessment matters.
You twisted your ankle months ago — maybe during a run, a weekend pickleball match, or a quick misstep on uneven ground. It seemed minor at the time. Yet the swelling never fully went away. Stairs feel uneasy. The joint feels unreliable on slopes. Something does not feel right.
This is the story many people tell orthopaedic surgeons, and according to Dr Tan Ken Jin, Orthopaedic surgeon (subspecialty interest in foot and ankle conditions), it is a sign that your seemingly trivial sprain may actually have been an ankle ligament tear.
Ankle injuries are among the most common musculoskeletal complaints worldwide. But what is less known is how often people underestimate the severity, and unknowingly allow a tear to linger, forming the foundation for long-term instability.
What Exactly Tears in the Ankle?
Most of us assume a sprain involves a mild overstretch of soft tissue. In reality, the ankle is held together by a network of ligaments that stabilise the joint every time you land, pivot, or walk on uneven ground.
Dr Tan highlights two key structures on the outer side of the ankle:
- ATFL (Anterior Talofibular Ligament)
- CFL (Calcaneofibular Ligament)
These are the ligaments most commonly torn when the foot points downward and rolls inward, a typical mechanism during sports, brisk walking, or even just missing a step while walking down the stairs.
When torn, these ligaments can no longer support the joint properly, which explains the chronic instability many people experience long after the initial swelling has faded.
Is It Just a Sprain, or Something More Serious?
Dr Tan describes a simple rule of thumb: a true sprain improves rapidly. A ligament tear, however, leaves clear warning signs.
- Significant swelling that lasts days
- Blue-black bruising from internal bleeding
- Sharp pain, especially during weight-bearing
- Difficulty walking
If these symptoms appear within the first 48-72 hours, the injury is likely more than a simple sprain.
Often, Dr Tan sees patients who only seek help one or two months after the initial injury, when the ankle simply refuses to heal. It is still swollen, still painful, still unstable. Many had assumed it was a routine sprain and chose to push through – continuing their runs, gym sessions or weekend sports.
Without early assessment, a ligament tear can go unnoticed, leaving the ankle to “heal” in the wrong way. When ankle instability persists for months or years, it often traces back to an untreated tear. Many people compensate unconsciously, shifting weight, avoiding certain surfaces, reducing activity.
Over time, this can lead to:
- Repeated sprains
- Chronic pain
- Joint cartilage wear
- Decreased confidence in mobility
Seeing a Doctor for Your Ankle Tear
When Should You See a Doctor?
There are two critical points for seeking help:
- Immediately, if walking is difficult and swelling is severe.
- Later, if symptoms persist beyond a month — especially instability or pain on slopes and stairs.
Early assessment prevents long-term complications. But even delayed treatment can be effective if the underlying cause is identified.
How Do Doctors Diagnose a Lingering Ankle Problem?
A thorough clinical exam is where it begins. Dr Tan emphasises several key steps:
- Checking your gait pattern
- Palpating the ligaments and surrounding bones
- Performing stress tests to assess ligament stability
If a tear is suspected, an MRI scan is usually recommended. This is the best way to see the full extent of damage and whether more than one ligament is involved.
Multiple ligament tears often represent a more serious injury and may guide the choice between conservative care and surgery.
What Happens If You Do Have a Tear?
Two main treatment paths exist:
- Conservative Management
This may include physiotherapy, bracing, and activity modification. It is typically offered to those with stable, partial tears or lower activity needs. - Surgical Repair
For individuals who are more active, or those whose tears cause persistent instability, Dr Tan often recommends surgical repair.
This decision depends not only on the injury but also on one’s lifestyle and goals: runners, hikers, and those who travel frequently often benefit from a more definitive repair.
What Does Surgical Repair of the Ankle Involve?
The most common technique is the Broström procedure, performed today using minimally invasive, arthroscopic (keyhole) methods.
During surgery, a small camera is inserted to view the torn ligaments. A suturing device reattaches them to their anatomical anchors, and tiny plastic or dissolvable pins secure the repair.
The procedure takes about 30–40 minutes, and most patients can walk immediately after with an ankle brace. Many go home the same day. The brace is usually worn for around three weeks, coupled with good post-op care and physiotherapy.
Who Actually Needs Surgery?
While surgery is common for young competitive athletes, it is not the only demographic who can benefit. Dr Tan notes that more middle-aged and older adults are choosing repair surgery because they want to stay active – be it travelling, hiking overseas, playing sports, or simply walking confidently without fear of rolling their ankle again.
A repaired ligament significantly reduces the 10-year risk of future ankle sprains, offering long-term stability and peace of mind.
TLDR: What Should You Do if Your Ankle Still Feels Wrong?
If your ankle is still swollen, painful or unstable after 1–2 months, seek an orthopaedic assessment. A lingering problem often indicates a ligament tear, not a sprain. Surgical repair can then reduce long-term sprain risk and restore confidence in movement.
FAQs
1. Why does my ankle still hurt months after a sprain?
Persistent pain often means a ligament tear did not heal properly. An MRI helps confirm this.
2. Can a torn ankle ligament heal without surgery?
Some partial tears can. Complete or multiple tears may require repair if instability persists.
3. When should I seek medical help?
Immediately if you cannot bear weight, and later if symptoms persist beyond a month.
4. Is surgery only for athletes?
No. Many middle-aged and older adults choose repair to stay active and prevent repeat sprains.
5. How soon can I walk after ligament repair?
Most patients can walk immediately with a brace and return home the same day.
