Joe A Shaw PA-C - 3/2/2010

Question
Hello. I am a 39 year old female, pretty active, mom of two young kids. I have never had an ankle problem before.
On Jan. 31st I didn't see a step and twisted my right ankle and fell.  I was unable to walk at all, the pain was severe.  I did RICE and went to the orthopedic doc the next morning.
X-rays showed a minor non-displaced fracture of the lateral malleolus (distal fibula).  I wore a cast for two weeks and at that point it was healed and I was put in an aircast ankle brace.  
When I still couldn't walk 3 weeks post injury I had an MRI.  The findings are as follows -
Sprain of ATFL - appears thicked and heterogeneous.
All other ligaments appear normal.
Bone bruises to the distal medial talus, in the posterior aspect of the medial malleolus and more focally at the posteromedial dome of the talus.
Distal fibula shows no sign of fracture and no bruise.
Tendons appear normal.
Tarsal sinus shows mild edema, possibly fluid tracking anteriorly from the posterior subtalar joint.
Bone marrow edema along the inferolateral portion of the cuboid, at the base of the fifth metatarsal and at the distal articular margin of the medial cuneiform.  The edema in the cuboid probably represents a bone bruise.  The other more focal sites of subcortical edema are suggestive of focal mild degenerative signal.
A small amount of deep subcutaneous edema overlies the origin of the plantar fascia and posterior inferior calcaneus.  No tear in plantar fascia and no plantar fascitis noted.
I am now 4 weeks past my accident and feel like I am getting nowhere.  Still have a lot of pain -i feel it some on the inner part of the ankle, some on top and most of it- the worst of it - is on the outside over the fibula area and next to that.  
I still cannot bear weight. The pain is intense with even partial weight bearing.  I do hot/cold hydrotherapy and then draw the alphabet with my big toe, do ROM - ankle up, down, in, out - and it hurts if I do too much.  
What to do next?  Shouldn't I be able to walk at this point?  I'm beginning to feel like I'll never walk again.
Please advise.
Thanks for your time.

Answer
I think 4 weeks in a cast then 2-4 wks in ankle brace with PT and weaning off might have been better..20/20 hindsight..4 wks is not that long for this type of injury, but you should start to see improvements I would think..may take 4-8 wks more for this to get better and 3-6 mos,to get max. improvement..and this is assuming you are generally healthy and normal weight.
You may want to try bio-freeze (non-RX) or Voltaren gel RX to massage in daily,along w NSAIDS if you can take them.