Biglou78,
You have had a pretty significant injury: a left ankle fracture-dislocation, which is actually a bimalleolar equivalent, Weber C, with disruption of the syndesmosis ligament.
In other words, the stress pattern of the injury went through the deltoid ligament on the medial side of the ankle (the inside), but rather than breaking the medial malleolus (the inside ankle bone), you tore the thick, very stout, deltoid ligament. The stress continued across the top of the plafond (the top of the ankle mortise), then went up between the tibia and fibula tearing the syndesmosis ligament. The stress then went laterally, fracturing the fibula. Because the syndesmosis ligament was disrupted, it allowed the mortise to widen, allowed the tibia and fibula to move away from each other (thus the dislocation).
The classification Weber C just means that the break in the fibula is above the level of the plafond (the top of the ankle mortise or ankle joint).
So, while most of these injuries end up having breaks in both malleoli (the ankle bones that stick out on both sides), you instead fractured the lateral malleolus (the distal fibula) and tore the deltoid ligament on the medial side. Thus, it is called a bimalleolar fracture equivalent.
Again, this is a pretty significant injury, with a lot of soft tissue damage. While it usually only takes around six weeks for the fibular fracture to heal, it can take a lot longer for the soft tissues to fully recover. As you have seen, it was 12 weeks before the surgeon felt comfortable enough to remove the syndesmosis screws.
Because of the extent of the soft tissue damage, it is going to be quite a while before you fully recover. All of the soft tissue has to heal, which it does with the formation of scar tissue. Every patient is unique, some form just enough scar to heal the tissues, while other make an abundant amount of scar. If you are one of the ones who makes a lot of scar tissue, that can often cause problems in regaining range of motion. Some patients with the injury which you sustained, just form a huge scar ball, all around the ankle joint. Of course, these patients have a lot of difficulty getting their range of motion back. They do not have the problem of laxity after this injury, but rather the problem of not getting the motion they need.
At the other end of the spectrum, you have the patients who just do not form enough scar tissue (which is actually unorganized collagen fibers). Because of this, often they do not form solid repairs of the ligaments, tendons, and joint capsule. They end up rupturing the repair early in the rehab process, and often have problems with joint laxity and instability.
But, fortunately, most patients are somewhere in the middle, healing with just the right amount of scar tissue that they need.
However, every patient is unique and will heal in his/her own way. This is why it is not really possible to tell you when you will no longer have any more swelling after activity. But, it is not uncommon for patients to continue to have activity related swelling for many months after an injury such as yours.
You should probably get some of the athletic support hose to wear. Often there are advertisements, here on the eHealth website, for just such garments. They are a little different than the usual support stockings or compression hose, as they are a little more stout and durable. They also come in a variety of colors and sizes. Since you seem to swell every time you are up and about, the compression garments will really help to reduce the formation of this edema.
Ice/heat and elevation will also help. Use of the calf muscles will also help to pump the edema back to the body core. The venous blood, the lymphatic fluid, and any subQ edema have to have muscle action to help move it up the leg towards the body. So, while you are elevating the foot (above your heart level, way up in the air), you should do ankle circles and calf pumps. The contraction of the calf muscles squeezes the veins and lymphatic channels, pushing/pumping the fluid up the tubes.
As to when you can return to play, probably the ultimate decision will be that of your orthopedic surgeon and/or the football league surgeon. But, to get to that point, if your team has an athletic trainer, you should be working very closely with him/her. If not, you might want to get hooked up with a physical therapist who specializes in sportsmedicine.
But, in general, you first need to work on getting full range of motion of the ankle, in all directions. You should do it actively (using your own muscles). If you do have some problems getting the final few degrees in any one direction, you might need some passive motion. Passive motion is where a therapist, or yourself, actually pushes on the foot to get those last few degrees.
You also need to work on strengthening all of the muscles around the foot, ankle, calf, and thigh (basically the whole lower extremity). At first, the use of an elastic band/tubing (such as TheraBand) is probably the best way to begin to strengthen after an ankle injury. If your Google “TheraBand exercises for the ankle”, you can get a whole lot of links to videos of how to use the TheraBand (elastic tubing/band) to rehab the ankle.
Then, you need to just get out and walk. You should not have a limp. If you have a limp, you have to figure out what is causing it: pain, decreased range of motion, not enough strength, loss of balance/agility, lack of confidence, and/or habit. Again, you have to figure out what’s the problem, and then focus on correcting that problem.
Some patients with significant ankle injuries like to have the ankle taped when doing activities. If you cannot get it taped, then you should probably get an ankle support/brace. The ones that you lace up are actually the ones that most closely approximate a tape job. The “stirrup” ones are okay, but many times they are very bulky and tend to shift around. They are fine for immobilizing an acute injury, but during rehab and when actually playing, the lace up ankle braces have been shown in research studies to be the best type.
So, you are out walking, without a limp. Once you can walk briskly for 3 to 5 miles, then you can go to jogging part of the distance. It is usually best to start jogging on a track, where there are no obstacles or irregular surfaces. Once you are able to jog 3 to 5 miles well, without any significant problems, then you can progress to sport specific activities.
You need to get out on the grass surface and start doing starts and stops. Running in large circles, slowly decreasing the size of the circles, till you can do sharp cuts and pivots. You need to run backwards and side to side. Basically working on all of the movements you are going to need to do at your position when you are playing.
While you are working on the running aspect, you also need to be in the gym regaining your muscle strength in the calf and thigh. Toe raises will get your gastroc and soleus complex in the back of the calf. You can hold onto weights while you do toe raises, if just your body weight is not enough to give you a workout. Knee extension for the quads and flexion for the hamstrings. Proper squats, dead lifts, and of course, do not forget the upper body.
You can also get on the stationary cycle to help with range of motion and strengthening. It is also good for overall cardiovascular conditioning. You have probably gotten quite a bit out of shape, while you were healing the fractures. Muscles atrophy very quickly and you lose your overall conditioning very fast. It is a lot easier to get out of shape, than it is to get back into shape.
You also need to work on any ball handling skills that you might need or any other specific motions/actions that you need for your specific position on the field. Getting into and out of the three point stance (or whatever your team uses), blocking, tackling, recovering a fumble, and any sort of activities that you need to be able to do.
Once you can do all of this easily (without any significant discomfort), you should be able to return to the starting lineup. As to when this will be, depends upon how you heal and how hard you work in therapy. We usually tell the athletes that for every day they are out of practice, it takes two to get back to the starting lineup. So, if you have not been doing a lot for, let’s say 4 months, it could take another 8 months to get back into playing shape. This is why it is not uncommon for it to take a year to 18 months to fully recover from an ankle injury like yours. This is not to say that you will not be able to do anything for that long, but that it may take that long till you know your final outcome.
Recovery does not “just happen”. It takes a lot of hard work, time, and sweat in the weight room and out on the track/playing field. The more you put into the therapy, the more you will get out of it.
Unfortunately, many patients try to return to play before they are ready. This is when reinjury is most likely to occur.
Again, if you have a trainer with your football team, get in contact with him/her and get a rehab program outlined. If not, see if your orthopedic surgeon can refer you to a physical therapist who specializes in sportsmedicine. Get a program to work on, and stick to it. It is like a job. You have to do the therapy at least 3 to 5 days a week. And, you should actually be doing something every day, even if that is just working on range of motion or taking a walk around the block.
Get a compressive garment (support hose) to help with the swelling, you would probably do best with the athletic type. Also, you might want to look into a lace up ankle brace and high top shoes/cleats.
If you have any questions or concerns, be sure to speak with your surgeon.
Good luck. Hope you can get back to the line up in the next season. It will be close, as that is only two months away. It might be possible, if you have healed well, and you really work hard on your rehabilitation program. But, do not go out before you are ready. That is just asking to be injured again.
Wishing you the best.