Is it possible for a 4 month old ankle sprain to need surgery. at the 3 week point had an x-ray but only showed lateral swelling. still hurts and pops?

Ankle sprain: Recommend you get an mri. You may have ligament tears that have not healed or joint surface damage that did not show on the x-ray.

Have it evaluated: Possible cause of your pain may include sprain, bursitis, fracture, contusion, neuritis, but of course there are a multitude of other possibilities. Get the feet inspected by a professional to determine the cause of the problem, as treatment varies depending on the diagnosis. Popping may be due to instability of the joint or bordering soft tissues.