Persistent Ankle Pain Following Sprain

Stretch Nerve Injury of the Superficial Peroneal Nerve and/or the Intermediodorsal Branch of the Fibular Nerve

Ankle injuries are quite common in life and they generally require little, if any, special medical attention.  A sprain is a stretch injury of a ligament or tendon, and rates of healing depend in large on patient age, health and nutritional status.

The most common sprain involves ‘inversion of the ankle.ankle sprain, pain center of orlando
More times than not, these sprains mend on their own in as little as 6 weeks (for children and adolescents) and the length of time tends to double with each decade of life, after the age of 30.

When the pain does not abate with time, the likelihood increases that pain is due to  stretch injury of the the Superficial Peroneal Nerve (SPN) and/or Intermediodorsal Branch of the Fibular Nerve (IBFN).  These nerves are tethered by the ligament that surrounds the lateral ankle,

extensor retinaculum ankle sprain, foot pain, pain center of orlando

and as it is turned inward, the nerves become frayed at the leading and trailing edges of the ankle.

ankle sprain, foot pain, pain center of orlando  The Nerve tissue is thin, delicate and easily damaged through violent stretch. The precise location of pain will depend entirely on the fibers that are injured.

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Pain can be rather incapacitating with pressure over the lateral portion of the ankle, and it can be worse with tight fitting shoes or boots.

These fibers will be compressed by certain types of shoes, sandals and boots, as can be seen in this picture.

Swelling will go away long before the pain is entirely gone.

Treatment of this problem consists of a combination of oral anti-inflammatories, oral anti-convulsants, and topical anti-inflammatory medicines.

The topical anti-inflammatory of choice may be a combination of flurbiprofen and ketoprofen in an isopropyl alcohol with NDMS enhancement. This is a compounded product, available by prescription.

An alternative that is available without prescription is ‘kink-ease,’ which is a high potency MSM salve.  In either case, the topical should be used first thing in the morning, last thing at night and once or twice during the day.

The Keto/flurbo compounded mixture must be ordered by your physician.  It costs about $40 per ounce.

Kink ease is available, without prescription, at a cost of about $4.50 an ounce. It can be found at this web address:


About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.