Ankle Sprains That Won't Heal: The Role of Injections, Imaging and Rehab
June 2026
By Essendon Sports Medicine Team
You rolled your ankle playing sport, stepping off a curb or simply landing awkwardly. It swelled quickly, it hurt to walk for a few days, and you were told it was "just a sprain."
Weeks later, however, something still doesn't feel right. The swelling comes and goes, your ankle feels unstable on uneven ground, or every attempt to return to running ends with the same familiar pain.
If this sounds familiar, you're not alone.
Ankle sprains are one of the most common musculoskeletal injuries seen in sports medicine, yet they are often underestimated.
While many recover well with appropriate treatment, a significant number of people continue to experience pain, weakness or instability long after the initial injury. In fact, research suggests that up to 40% of individuals develop persistent symptoms or recurrent sprains following an ankle injury.
The good news is that ongoing symptoms don't necessarily mean you'll always have ankle problems. They do, however, mean it's worth taking a closer look. Knowing when to see a sports doctor, when imaging is helpful, whether injections have a role, and why structured ankle sprain rehab is essential can make all the difference to your recovery.
What You’ll Learn in This Blog:
- Why some ankle sprains don't heal as expected and the common injuries that can be missed.
- When imaging or injections may be appropriate—and when they're not.
- How evidence-based ankle sprain rehab can help you recover fully and reduce the risk of future sprains.
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Why do some ankle sprains take so long to heal?
Most ankle sprains occur when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle. The severity can range from mild stretching of the ligament fibres through to a complete rupture.
Many people expect the pain to disappear within a couple of weeks, but healing isn't always that straightforward. Ligaments have a relatively limited blood supply, meaning they often heal more slowly than muscles. More importantly, healing isn't just about the ligament itself. The injury can affect balance, muscle strength, coordination and the body's ability to react quickly when the ankle is placed under stress.
Sometimes, the original diagnosis may not tell the whole story. Persistent symptoms can occur because of injuries that accompany or mimic a simple ankle sprain, including:
- Syndesmosis ("high ankle") sprains.
- Peroneal tendon injuries.
- Osteochondral injuries involving the cartilage and bone within the ankle joint.
- Small fractures that were not initially obvious.
- Chronic ankle instability following repeated sprains.
- Persistent inflammation within the joint.
Without identifying the underlying cause, it's easy to assume the ankle simply needs more time. In reality, ongoing pain often signals that further assessment is warranted.
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When should you see a sports doctor for a sprained ankle?
Not every ankle sprain requires specialist assessment, but there are situations where seeing a sports doctor can help prevent ongoing problems.
If your ankle remains swollen after several weeks, repeatedly gives way, feels unstable, or you're struggling to return to work, exercise or sport, a comprehensive assessment can help determine why your recovery has stalled.
Sports doctors have expertise in diagnosing both common and complex musculoskeletal injuries. Rather than simply treating the pain, they aim to identify exactly which structures have been injured and whether anything has been overlooked.
A consultation may include:
- A detailed history of how the injury occurred.
- Assessment of ligament stability.
- Examination of tendon function.
- Evaluation of joint movement and swelling.
- Functional testing including balance and single-leg control.
- Determining whether imaging or further treatment is appropriate.
Perhaps most importantly, a sports doctor can coordinate the next stage of your management, whether that involves physiotherapy, imaging, injection therapy in selected cases or referral for surgical opinion if necessary.
Does every ankle sprain need imaging?
One of the most common questions people ask is whether they should have an X-ray or MRI straight away.
The answer is usually no.
Most uncomplicated ankle sprains can be diagnosed through a thorough clinical examination without immediate imaging. In fact, unnecessary scans often identify findings that may not be contributing to your symptoms and can complicate decision-making.
Instead, imaging should answer a specific clinical question.
X-rays for ankle sprains
X-rays are primarily used to identify fractures. Sports doctors often use the Ottawa Ankle Rules, an evidence-based clinical decision tool that helps determine whether an X-ray is likely to be necessary following an acute injury.
Ultrasound for ankle sprains
Ultrasound can be useful for assessing tendons and some ligament injuries, particularly when dynamic movement is important. It can also guide certain injection procedures when appropriate.
MRI for ankle sprains
MRI provides the most detailed assessment of the ankle's soft tissues, cartilage and bone.
A sports doctor may recommend MRI if:
- Pain persists longer than expected.
- There is ongoing swelling despite appropriate management.
- A cartilage injury is suspected.
- A syndesmosis injury is possible.
- Symptoms don't match the expected recovery pattern.
- Surgical planning is being considered.
Rather than ordering scans routinely, the goal is to ensure imaging provides information that genuinely changes management.
Do injections help ankle sprains?
Many people wonder whether an injection could speed up recovery after an ankle sprain.
For most acute ankle sprains, the answer is no. Structured ankle sprain rehab remains the cornerstone of treatment, and injections are not considered routine management.
However, there are situations where a sports doctor may consider injection therapy as part of an individualised treatment plan.
For example, persistent inflammation inside the ankle joint (synovitis) may occasionally respond to an ultrasound-guided corticosteroid injection when conservative management has not been successful.
Platelet-rich plasma (PRP) injections have also attracted considerable interest. PRP involves concentrating a person's own platelets and injecting them into injured tissue with the aim of supporting healing. While some studies have reported potential benefits for certain musculoskeletal conditions, the evidence for routine use in ankle ligament injuries remains mixed. Current research does not support PRP as standard treatment for uncomplicated ankle sprains, although it may be considered in carefully selected cases after discussion of the available evidence.
The important point is that injections should never replace a thorough assessment or structured rehabilitation. They may have a role for specific diagnoses, but they are only one component of a comprehensive management plan.
Why ankle sprain rehab is so important
Regardless of whether imaging or injections are required, successful recovery almost always depends on high-quality ankle sprain rehab.
This is where physiotherapists play a crucial role, especially our onsite team at Melbourne Sports Physiotherapy.
Many people stop rehabilitation once they can walk without pain. Unfortunately, this is often when the ankle remains most vulnerable. Pain may settle well before balance, strength and neuromuscular control have fully recovered.
Effective ankle sprain rehab progresses through several stages.
Initially, the focus is on reducing pain and swelling while restoring normal ankle movement. Gentle mobility exercises, gradual weight-bearing and appropriate loading encourage healing without overstressing the injured tissues.
As symptoms improve, rehabilitation shifts towards rebuilding strength throughout the ankle, calf and lower limb. This includes strengthening not only the muscles around the ankle but also the hips and core, which contribute significantly to lower limb control during walking, running and jumping.
Balance and proprioception training are among the most important components of ankle sprain rehab. Following a ligament injury, the body's ability to detect joint position can become impaired. This increases the likelihood of the ankle rolling again, even if the ligament itself has healed.
Exercises such as single-leg balance, unstable surface training, hopping drills and direction changes help retrain the body's protective reflexes and reduce the risk of recurrent injury.
For athletes and active individuals, rehabilitation also needs to include sport-specific preparation. Running, sprinting, jumping, cutting and landing all place significant demands on the ankle. Returning to these activities without appropriate progression increases the risk of another sprain.
A physiotherapist can gradually reintroduce these movements while monitoring symptoms and ensuring your ankle is coping with increasing loads.
Research consistently shows that structured rehabilitation significantly reduces recurrent ankle sprains and improves long-term function compared with rest alone.
What many people don't realise about ankle sprains
One reason ankle sprains become chronic is that they are often treated as a short-term injury rather than a condition requiring progressive rehabilitation.
Pain is only one part of recovery.
Studies have shown that balance deficits can persist long after discomfort has resolved. Muscle weakness may remain even when walking feels completely normal. Previous ankle sprains also increase the likelihood of future injuries, particularly if rehabilitation is incomplete.
Another commonly overlooked factor is confidence. Many people unconsciously protect the injured ankle during sport or exercise, altering their movement patterns without realising it. Over time, these compensations can contribute to problems elsewhere, including the knee, hip or lower back.
A comprehensive management plan addresses not only tissue healing but also movement quality, strength, confidence and return-to-sport readiness.
A team approach leads to better outcomes for ankle sprains
Persistent ankle pain is rarely solved by one treatment alone.
The best outcomes often come from a coordinated approach involving accurate diagnosis, evidence-based rehabilitation and ongoing review as recovery progresses.
Sports doctors play an important role in identifying the exact cause of ongoing symptoms, determining when imaging is appropriate and advising whether interventions such as injections may be beneficial for specific conditions.
Physiotherapists then guide progressive ankle sprain rehab, helping restore mobility, strength, balance and confidence while supporting a safe return to everyday activities, work and sport.
Working together ensures that treatment addresses both the underlying diagnosis and the functional recovery needed to reduce the risk of future injury.
Don't let a lingering ankle sprain become a long-term problem
If your ankle is still painful, swollen or unstable weeks after your injury, or you've experienced multiple sprains affecting the same ankle, it may be time to look beyond simply resting and hoping it improves.
At Essendon Sports Medicine, our experienced sports doctors provide comprehensive assessment of ankle injuries, helping determine whether further investigation, imaging or treatments such as injection therapy are appropriate. Working closely with our physiotherapy team, we develop personalised ankle sprain rehab programs designed to restore strength, improve stability and support a safe return to the activities you enjoy.
If your recovery has stalled or you're ready to get back to sport with confidence, book an appointment with the team at Essendon Sports Medicine and let us help you take the next step towards a stronger, more resilient ankle.
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