You twisted your ankle.

It swelled up.

You rested it, iced it, perhaps wore an ankle brace and waited for it to recover.

But several weeks later, it still hurts.

Maybe:

• Walking is still painful
• The ankle remains swollen
• It hurts when you go down stairs
• Running is impossible
• The ankle feels unstable
• It keeps “giving way”
• There is one particular spot that remains very tender
• Physiotherapy does not seem to be solving the problem

Ankle sprains are extremely common, and many improve without extensive investigation.

But persistent pain after an ankle sprain deserves reassessment because what initially appeared to be a simple sprain can sometimes involve:

• A more significant ligament injury
• Ongoing ankle instability
• Tendon injury
• An osteochondral injury involving cartilage and bone
• A fracture that was not initially obvious
• Another ankle problem

Mayo Clinic advises medical reassessment when a sprained ankle does not improve with self-care or continues to cause pain or instability.

How Long Should an Ankle Sprain Take to Heal?

There is no single recovery time.

A mild ankle sprain may improve relatively quickly.

A more significant ligament injury can take considerably longer.

Mayo Clinic notes that recovery from sprains can range from days to months depending on the severity of the injury.

The more useful question is:

Is the ankle progressively improving?

You should generally expect some improvement in:

• Swelling
• Walking ability
• Range of movement
• Balance
• Strength
• Confidence on the ankle

If none of these are improving, simply continuing to wait may not be the best strategy.

What Actually Happens During an Ankle Sprain?

An ankle sprain occurs when the ankle twists beyond its normal range and one or more supporting ligaments are stretched or torn.

Most ankle sprains affect ligaments on the outer side of the ankle.

Symptoms may include:

• Pain
• Swelling
• Bruising
• Tenderness
• Reduced movement
• Difficulty putting weight on the foot
• A feeling that the ankle is unstable

Mayo Clinic notes that ankle sprains range from ligament stretching to partial or complete tearing.

Why Is My Ankle Still Painful After Several Weeks?

There are several possibilities.

1. The Ligament Injury May Have Been More Significant Than Expected

Not every ankle sprain is minor.

A ligament may be:

• Stretched
• Partially torn
• Completely torn

A more significant injury may produce:

• Persistent swelling
• Pain when walking
• Instability
• Difficulty returning to sport

MRI can show the ankle ligaments in considerably more detail than an ordinary X-ray. Mayo Clinic notes that MRI produces detailed images of soft tissues including the ligaments.

2. The Ankle May Have Become Unstable

Some people recover from the initial pain but are left with an ankle that repeatedly:

• Gives way
• Rolls easily
• Feels insecure on uneven ground
• Feels unreliable during sport

Previous ankle sprains also increase the risk of further sprains.

Mayo Clinic lists ongoing instability and recurrent sprains among potential complications of inadequately rehabilitated ankle injuries.

For chronic ankle instability, ultrasound or MRI may sometimes be appropriate when X-rays do not explain the symptoms.

3. A Tendon May Also Have Been Injured

The ankle contains several tendons that can be injured at the same time as the ligaments.

Persistent pain may sometimes involve:

• Peroneal tendons on the outer ankle
• Posterior tibial tendon on the inner ankle
• Achilles tendon at the back of the ankle
• Other surrounding soft tissues

This may be more likely when pain is highly localised or appears with specific movements.

For suspected tendon abnormalities in chronic ankle pain, ultrasound or MRI may be appropriate.

4. There May Be an Osteochondral Injury

An ankle twist can sometimes damage the:

• Cartilage
• Underlying bone

of the ankle joint.

This is known as an osteochondral lesion.

It may produce:

• Persistent deep ankle pain
• Swelling
• Pain during weight-bearing
• Catching or locking sensations

These injuries may not always be obvious on an ordinary X-ray.

The American College of Radiology notes that CT or MRI may be appropriate when an osteochondral lesion is suspected in someone with persistent ankle pain.

5. There May Be a Fracture

Sometimes an injury initially thought to be a sprain turns out to involve a fracture.

This becomes more important if you have:

• Severe bone tenderness
• Difficulty bearing weight
• Significant swelling
• Persistent pain despite treatment

X-ray is usually the first imaging test when fracture is suspected.

Mayo Clinic notes that X-rays are useful for ruling out broken bones after an ankle injury.

Why Is My Ankle Still Swollen?

Swelling can persist for some time after a significant sprain.

However, ongoing swelling together with:

• Persistent pain
• Instability
• Limited movement

may justify reassessment.

Mayo Clinic recommends medical review when ankle swelling remains constant despite several days of home treatment or pain persists for several weeks.

Why Does My Ankle Hurt When I Walk?

Walking places repeated load through the ankle.

Persistent pain during walking can occur because:

• A ligament is still healing
• The ankle remains stiff
• The joint surface is irritated
• A tendon is injured
• A fracture or bone injury is present
• The ankle remains unstable

Pain when bearing weight is one of the common symptoms of an ankle sprain, but it should gradually improve.

Why Does My Ankle Hurt When Going Down Stairs?

Going downstairs requires ankle movement, balance and controlled loading.

Pain can be more noticeable if there is:

• Reduced ankle mobility
• Ligament instability
• Persistent swelling
• Joint irritation
• Muscle weakness

This does not automatically mean there is a severe injury, but persistent difficulty with stairs can indicate incomplete recovery.

Why Does My Ankle Keep Giving Way?

Repeated giving way suggests the ankle may not have fully regained:

• Ligament stability
• Strength
• Balance
• Proprioception

Proprioception is your body’s ability to sense joint position.

After a sprain, this system can become impaired.

Mayo Clinic emphasises strengthening and balance exercises as part of ankle rehabilitation to restore stability and reduce future sprains.

Do I Need Physiotherapy After an Ankle Sprain?

Not every minor sprain requires formal physiotherapy.

But rehabilitation becomes particularly useful when:

• Walking remains difficult
• The ankle is weak
• Balance is poor
• You want to return to sport
• The ankle feels unstable
• You have had repeated sprains

Physiotherapy may include:

• Restoring ankle movement
• Calf strengthening
• Ankle strengthening
• Balance exercises
• Proprioception training
• Gradual return to running or sport

Mayo Clinic specifically highlights strengthening and balance exercises as important for restoring ankle function and preventing recurrence.

What if Physiotherapy Is Not Working?

If you have completed an appropriate rehabilitation programme but still have:

• Significant pain
• Swelling
• Instability
• Difficulty walking
• Inability to return to sport

the ankle may need to be reassessed.

Questions include:

• Was this actually a simple ligament sprain?
• Is there a more significant ligament tear?
• Is a tendon injured?
• Is there a cartilage or bone injury?
• Was a fracture missed?
• Would imaging change treatment?

Continuing exactly the same rehabilitation indefinitely is not always the best next step when progress has clearly stalled.

Should I Rest Until All the Pain Is Gone?

Complete prolonged rest is usually not the goal for most uncomplicated sprains.

Once the initial pain and swelling settle, rehabilitation normally progresses toward restoring:

• Movement
• Strength
• Flexibility
• Stability

Mayo Clinic recommends progression into exercises once pain and swelling improve rather than indefinite immobilisation.

The appropriate amount of activity depends on injury severity.

Should I Keep Walking on a Painful Ankle?

This depends on how severe the symptoms are.

A small amount of discomfort during recovery may not necessarily be harmful.

But continuing to walk normally despite:

• Severe pain
• Major limping
• Increasing swelling
• Inability to bear weight

deserves reassessment.

The NHS advises urgent assessment when severe ankle pain prevents walking.

When Should I Have an X-Ray?

X-ray is particularly useful when there is concern about:

• Fracture
• Bone injury
• Arthritis
• Other bone abnormalities

For chronic ankle pain lasting six weeks or longer, the American College of Radiology recommends X-ray as the usual first imaging investigation.

Can an X-Ray Show Ligament Damage?

Not directly.

X-rays are primarily designed to show bones.

They can help identify fractures and certain joint abnormalities but do not provide the same soft-tissue detail as:

• Ultrasound
• MRI

If significant ligament or tendon injury remains suspected, another form of imaging may be more useful.

When Is Ultrasound Useful?

Ultrasound can provide real-time assessment of:

• Tendons
• Selected ligaments
• Other superficial soft tissues

Mayo Clinic notes that ultrasound can help assess the condition of an ankle ligament or tendon while the foot is positioned in different ways.

For persistent suspected tendon abnormalities or ankle instability, ultrasound may sometimes be appropriate.

When Is MRI Useful After an Ankle Sprain?

MRI becomes more useful when persistent symptoms raise concern about:

• Significant ligament injury
• Chronic ankle instability
• Tendon injury
• Osteochondral injury
• Other internal ankle abnormalities

Mayo Clinic notes that MRI can provide detailed images of the ankle’s soft tissues, including the ligaments.

For chronic ankle pain where X-rays are normal but certain conditions remain suspected, the American College of Radiology identifies MRI without contrast as an appropriate investigation.

What Can an Ankle MRI Show?

Depending on the problem, MRI can assess:

• Ligaments
• Tendons
• Cartilage
• Bone marrow
• Joint surfaces
• Muscles
• Other soft tissues

This can be useful when symptoms remain unexplained by an X-ray.

Do I Need an MRI Immediately After Every Ankle Sprain?

No.

Most ordinary ankle sprains do not require MRI.

The initial diagnosis is usually based on:

• How the injury happened
• Tenderness
• Swelling
• Ability to bear weight
• Range of motion
• Physical examination

Imaging becomes more important when there is concern about a fracture or a more significant injury.

What if My Ankle Is Still Painful After 6 Weeks?

Pain lasting six weeks or more is generally considered chronic ankle pain for imaging purposes.

At this stage, X-ray is commonly the first imaging test.

If X-ray does not explain the symptoms and the doctor suspects a ligament, tendon, cartilage or other soft-tissue injury, MRI or ultrasound may be considered.

What if My Ankle Still Hurts After 3 Months?

At three months, persistent symptoms deserve closer assessment, particularly if you still have:

• Limping
• Swelling
• Instability
• Difficulty with stairs
• Inability to run
• Inability to return to sport

This does not automatically mean surgery is needed.

It does mean that simply calling the problem “a sprain” may no longer be sufficiently specific.

Does Persistent Pain Mean the Ligament Is Torn?

Not necessarily.

Persistent pain can come from:

• Ligament injury
• Tendons
• Cartilage
• Bone
• Joint stiffness
• Incomplete rehabilitation

Imaging should therefore answer a specific clinical question rather than simply look for “something wrong”.

Does a Torn Ankle Ligament Always Need Surgery?

No.

Many ligament injuries can still be managed without surgery.

Treatment may include:

• Bracing
• Physiotherapy
• Strengthening
• Balance training
• Gradual return to activity

Mayo Clinic notes that surgery for ankle sprains is uncommon and is generally reserved for injuries that fail to heal or ankles that remain unstable despite prolonged rehabilitation.

What if I Keep Spraining the Same Ankle?

Repeated ankle sprains deserve assessment.

Previous ankle injury is itself a risk factor for another sprain.

Repeated sprains can indicate:

• Persistent ligament laxity
• Poor balance
• Muscle weakness
• Inadequate rehabilitation
• Chronic ankle instability

Treatment should therefore focus not only on relieving pain but also on restoring ankle control.

What if I Feel Clicking, Catching or Locking?

Persistent mechanical symptoms after a sprain can raise concern about an internal joint problem such as an osteochondral injury.

MRI may be useful if the clinical assessment suggests a cartilage or bone-surface injury that is not clearly visible on X-ray.

When Should I See a Doctor?

Arrange an assessment if:

• Ankle pain is not improving after several weeks
• Swelling persists
• Walking remains difficult
• The ankle repeatedly gives way
• You cannot return to normal activity
• Physiotherapy is not helping
• You have repeatedly sprained the same ankle

Mayo Clinic recommends medical review for persistent ankle pain that does not improve after several weeks.

When Is Ankle Pain Urgent?

Seek prompt medical attention if:

• You cannot put weight on the foot
• The ankle or foot looks deformed
• You heard a significant snap or grinding sound
• There is severe pain after injury
• There is numbness
• There is an open wound
• The ankle is hot, swollen and associated with fever

Mayo Clinic and the NHS identify inability to bear weight, deformity and severe symptoms after injury as reasons for urgent assessment.

How Much Does an Ankle MRI Cost in Singapore?

For many patients arranging an ankle MRI through The Pain Relief Clinic, the current price is approximately:

S$1,000

This generally includes:

• MRI examination
• MRI images
• Formal radiologist’s report

Eligible outpatient diagnostic scans may qualify for up to:

S$600 per patient per year from MediSave

subject to prevailing requirements and remaining withdrawal limits.

Singapore’s Ministry of Health confirms that the annual MediSave withdrawal limit for outpatient diagnostic scans increased from S$300 to S$600 from 1 January 2026.

How Quickly Can I Get an Ankle MRI?

When MRI is medically appropriate, The Pain Relief Clinic can often arrange ankle imaging:

Within one working day

subject to:

• MRI safety screening
• Correct imaging protocol
• Appointment availability

Frequently Asked Questions About Persistent Ankle Pain After a Sprain

Why is my ankle still hurting weeks after a sprain?

Possible reasons include incomplete ligament healing, persistent instability, tendon injury, cartilage damage, joint stiffness or an overlooked fracture.

Is it normal for an ankle sprain to hurt for several weeks?

Yes. More significant sprains can remain painful or swollen for several weeks, but there should generally be a gradual trend toward improvement.

When should I worry about an ankle sprain?

Seek reassessment if pain is persistent, you cannot walk normally, swelling remains significant, or the ankle repeatedly gives way.

Why does my ankle keep giving way?

This may indicate incomplete strength and balance recovery or chronic ligament instability.

Do I need an X-ray?

X-ray is often the first imaging test when fracture is suspected and is generally the first imaging investigation for chronic ankle pain lasting six weeks or more.

Do I need an MRI?

Not automatically. MRI becomes more useful when persistent symptoms suggest ligament, tendon, cartilage or other structural injury that is not adequately explained by X-ray.

Can MRI show ankle ligaments?

Yes. MRI provides detailed imaging of the soft tissues of the ankle, including the ligaments.

Can ultrasound show an ankle ligament or tendon problem?

Yes. Ultrasound may be useful for selected ligament and tendon abnormalities and allows dynamic assessment.

Does a torn ankle ligament always require surgery?

No. Surgery is uncommon and is generally reserved for persistent instability or injuries that fail to recover despite appropriate rehabilitation.

How much does an ankle MRI cost?

An ankle MRI arranged through The Pain Relief Clinic is currently approximately S$1,000, including the scan images and formal radiologist’s report.

Ankle Sprain Still Not Improving?

If you twisted your ankle weeks or months ago but are still experiencing pain, swelling or instability, it may be useful to determine whether the injury involved more than a straightforward sprain.

At The Pain Relief Clinic, we can assess:

• Ankle movement
• Ligament stability
• Strength and balance
• The exact location of persistent tenderness
• Whether a tendon injury may be present
• Whether X-ray, ultrasound, MRI or no additional imaging is most appropriate
• Whether the rehabilitation programme should change

When MRI is medically indicated, ankle imaging can often be arranged within one working day.

Persistent ankle pain assessment through The Pain Relief Clinic

• Medical assessment by a licensed medical doctor
• In-house physiotherapy
• Assessment of ankle stability and function
• Review of previous rehabilitation
• Fast access to imaging when indicated
• Ankle MRI often available within one working day
• Approximately S$1,000 for many ankle MRI examinations
• Up to S$600 MediSave for eligible outpatient diagnostic scans
• Formal radiologist’s report
• Non-surgical treatment options where appropriate
• Referral for orthopaedic review when appropriate

Arrange an Ankle Pain Assessment

The Pain Relief Clinic

Call / WhatsApp: +65 9068 9605

If your ankle is still painful, swollen or unstable several weeks after a sprain — particularly if physiotherapy has not restored normal walking or activity — contact us for an assessment of whether the diagnosis, imaging or rehabilitation plan should be reconsidered.

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References

1. Mayo Clinic — Sprained Ankle: Symptoms and Causes, updated 19 June 2026.
2. Mayo Clinic — Sprained Ankle: Diagnosis and Treatment, updated 19 June 2026.
3. Mayo Clinic — Ankle Pain: When to Seek Medical Advice.
4. RadiologyInfo.org / American College of Radiology — Chronic Ankle Pain.
5. NHS — Ankle Pain, reviewed 20 November 2025.
6. Singapore Ministry of Health — Outpatient Care, updated 1 June 2026.
7. Singapore Ministry of Health — Adequacy of S$600 Annual MediSave Withdrawal Limit for Outpatient CT and MRI Scans, 6 August 2026.

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Important Medical Information

This article provides general educational information and does not replace an individual medical consultation.

Persistent ankle pain following a sprain can result from ligament injury, tendon problems, joint instability, cartilage or bone injury, fracture or other causes. The duration of pain alone cannot determine the diagnosis.

Imaging is not required for every ankle sprain. The appropriate investigation depends on how the injury occurred, ability to bear weight, examination findings, duration of symptoms, treatment response and whether imaging would change management.

Seek prompt medical attention if you cannot bear weight after an injury, the ankle is visibly deformed, there is major numbness, severe pain, an open wound, or increasing heat and swelling associated with fever.

Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 18 September 2026