Ankle swelling five months after sprain?

[Avib101]

Hello,

I sprained my ankle running about five months ago (December 9th). X-rays, both the day of, and four weeks after, we’re negative for fractures. I had an MRI on February 19th (results below). I’ve been doing very disciplined PT and haven’t ran since the sprain. I’m still having significant swelling and some instability and pain when walking. Pain has improved a bit, but the swelling very minimally. My orthopedist keeps saying to give it more time. I’d appreciate another perspective. Thanks!


FINDINGS: Comparison is made to plain film radiographs of the ankle  
     which demonstrated significant soft tissue swelling overlying the  
     lateral malleolus on the examination from 12/9/2018.  

     Vitamin E tablets were placed overlying the extensor digitorum longus  
     and brevis tendons, along the posterolateral aspect of the ankle, and  
     along the medial aspect of the ankle.  

     The anterior talofibular ligament is intact although the ligament is  
     somewhat thickened see image #15 from series 7. The posterior  
     talofibular ligament and the calcaneofibular ligament image in a  
     normal fashion. The anterior inferior and posterior inferior  
     tibiofibular ligaments and the interosseous membrane image in a normal  
     fashion.  

     There is thickening and increased T2 signal involving the more  
     posterior component of the deltoid ligament see image #13 from series  
     7 and image #16 from series 6. This affects the region of the  
     tibiocalcaneal the posterior tibiotalar ligaments. The spring ligament  
     is apparently intact.  

     There are normal signal characteristics within the tibialis posterior  
     tendon although there is a small amount of fluid signal within the  
     tendon sheath. This is demonstrated on images #7 and #8 as well as  
     image #17 from series 8. There are normal signal characteristics  
     within the flexor hallucis longus and flexor digitorum longus tendons.  
     There also are normal signal characteristics within the peroneus  
     brevis and longus tendons. There is a retromalleolar positioning of  
     the peroneus longus and brevis tendons. The peroneus brevis tendon is  
     positioned somewhat laterally relative to the peroneus longus tendon.  
     The usual positioning is immediately posterior to the peroneus longus  
     tendon. This is of questionable clinical significance.  

     The talar dome images in a normal fashion without discrete  
     osteochondral lesions. The fat within the sinus Tarsi is Maintained.

       This examination is negative for subtalar tarsal coalition.  

     The plantar fascial and Achilles tendon insertion site image in a  
     normal fashion.  

       IMPRESSION:  
       1.  The patient likely sustained a sprain of his anterior talofibular  
       ligament. There is mild thickening of the ligament but without  
       disruption. On occasion granulation tissue along the healed anterior  
       talofibular ligament may be associated with an anterior lateral  
       impingement syndrome. In this case the ligament is fairly uniform in  
       thickness without replacement by granulation tissue.  
       2.  There also are findings suggesting a prior sprain along the more  
       posterior aspect of the deltoid ligamentous complex.  
       3.  There is increased fluid signal intensity within the tendon sheath  
       of the tibialis posterior tendon may be a manifestation of  
       tenosynovitis.  
       4.  This examination is negative for an occult fracture of the ankle  
       or an osteochondral lesion.