Produced by Dylan Merkett, Bupa Health Information Team, January 2012.

This factsheet is for people who have a sprained ankle, or who would like information about it.

A sprained ankle occurs when a ligament is excessively stretched, twisted or torn. A ligament is a tough, flexible, fibrous tissue that connects one bone to another to form a joint.

 
About sprained ankles
Symptoms of a sprained ankle
Causes of a sprained ankle
Diagnosis of a sprained ankle
Treatment of a sprained ankle
Prevention of a sprained ankle
Video
 

About sprained ankles

Sprained ankles are one of the most common musculoskeletal injuries.

Sprained ankles are classified into the following grades.

  • Mild (grade I) – stretched or partial tear of a ligament with no loss of ability to put weight on your injured foot.
  • Moderate (grade II) – incomplete tear of a ligament with moderate loss of ability to put weight on your injured foot.
  • Severe (grade III) – complete tear of a ligament which may result in total loss of ability to put weight on your injured foot.

Symptoms of a sprained ankle

The symptoms associated with a sprained ankle include:

  • pain
  • swelling
  • bruising
  • restricted movement
  • limited ability to put weight on the injured foot

A sprained ankle can be very painful with the pain getting worse if you move your foot. Your ankle will start to swell immediately and will be tender to touch. Bruising will appear around the injury but this can take hours or even days to appear. If your sprain is severe, you may not be able to put any weight on your foot.

You may hear a popping or cracking sound at the time of injury. Although this can be alarming it isn't usually a sign of the severity of your injury.

Causes of a sprained ankle

A sprained ankle is most commonly caused by your foot twisting inwards making the ligaments on the outside of your ankle stretch past their normal range. This is known as an inversion sprain.

A sprained ankle can be caused by:

  • walking on irregular surfaces
  • losing your balance while wearing high heels
  • an impact on your ankle during sports
  • landing awkwardly from a jump

You're more likely to sprain your ankle if you have done so previously. This is possibly because the ligaments didn't heal properly the first time so they are weaker. It may also be because you damaged nerves in your ankle previously and if not fully rehabilitated the muscles can remain weak.

 

Diagnosis of a sprained ankle

Your doctor or physical therapist (physiotherapist) will ask about your symptoms and examine you. He or she may also ask you about your medical history and to describe exactly how you injured your ankle.

Your doctor or physical therapist will want to rule out a broken bone (fracture) and assess how severe your injury is. He or she may ask you to walk a few steps to see if you can put weight on your foot. This will help your doctor decide the best treatment for you.

You may need an X-ray if your doctor thinks your injury is severe and may need more specific treatment.
Please note that availability and use of specific tests may vary from country to country.

 

Treatment of a sprained ankle

It's important that you begin to treat your sprained ankle as soon as possible. This will speed up your return to activity and reduce the chance of it happening again.
 
Self-help
In the first 48 to 72 hours after your injury, it's important to follow the PRICE procedure. Many minor sprains and strains will respond well to this.

  • Protect your injury from further harm.
  • Rest your injury for the first two to three days, and then re-introduce movement so you don't lose too much muscle strength.
  • Ice the injured area using an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don't apply ice directly to your skin as it can damage your skin.
  • Compress the area by bandaging it to support the injury and help reduce swelling. The bandage should fit snugly but not be too tight, and you should remove it before going to sleep.
  • Elevate the injured area above the level of your heart to control swelling. Keep the area supported and try to keep it elevated as much as possible until the swelling goes down.

 
If your injury doesn't improve, it's important to seek advice from your doctor or physical therapist.

For the first 72 hours there are certain things you shouldn't do. These can be remembered using HARM.

  • Heat. Don't use heat packs, hot water bottles or heat rubs on the affected area, as well as saunas or hot baths. Heat encourages blood to flow to the area, the opposite effect of using ice.
  • Alcohol. Don't drink alcohol because it can increase bleeding and swelling to the area, slowing down the healing process.
  • Running or any other form of strenuous exercise. Such activities may cause more damage.
  • Massage. This can increase bleeding and swelling.

As soon as you feel that your pain is tolerable, begin gentle stretching exercises to keep your ankle moving and help decrease the pain and swelling.

Doing five repetitions of the following exercises, three to five times a day, can help you to get back the movement in your ankle in all directions.

  • Achilles tendon stretch. Sit on the floor with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and gently pull your toes towards your head while keeping your leg straight. Hold for 20 to 30 seconds.
  • Alphabet exercise. Try to draw the letters of the alphabet in lower case and upper case on the floor with your big toe.

 
Your doctor or physical therapist will probably give you exercises to do once you can stand without pain. These exercises will aim to strengthen the muscles around your ankle making a repeat injury less likely.


 Medicines

You can take paracetamol (acetaminophen) immediately to help relieve pain and swelling. Your doctor may prescribe codeine if your pain is severe.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.
 

Physical therapy (physiotherapy)
Physical therapy can help restore your range of movement, strength and balance. This can be done with a number of techniques, such as:

  • massage
  • ultrasound
  • joint and nerve mobilisation
  • exercises to increase your range of movement, strength and balance
  • assisting in returning you to a specific sport
  • taping or having a brace placed around your ankle

Surgery

Surgery for a sprained ankle is rare because there isn't enough evidence to suggest that it's more effective than physical therapy and exercise. However, if your ankle is still causing you pain and giving way after you have tried all physical therapy options, your doctor may refer you to an orthopaedic surgeon (a doctor who specialises in bone surgery) or a sports injury specialist.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.
 

After your treatment

The length of time it takes you to recover from a sprained ankle will depend on how severe your injury is.

If you don't have any complications, you will probably be able to walk within one to two weeks and achieve full movement of your ankle within six to eight weeks.
 

Prevention of a sprained ankle

It's impossible to totally remove the likelihood of spraining your ankle but there are a number of ways you can help prevent a sprained ankle. The most important thing you can do is to maintain the strength, flexibility and balance of the muscles surrounding your ankle. Some other examples are listed below.
 

  • Wear shoes that fit and are appropriate for the activity you're doing.
  • Take care when wearing high-heeled shoes and walking on uneven surfaces.
  • Wearing a semi-rigid ankle brace has been shown as an effective way of preventing you from spraining your ankle again. A semi-rigid ankle brace has a slightly stiff shell that helps to remove pressure on your ankle while still allowing you to move your ankle freely. Your physical therapist can give you advice if they think it's a good idea for you to wear one.

Video

See our video about sprained ankles.

Treating sprains and strains

Answers to questions about sprained ankle
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 
How long will it take to recover fully from a sprained ankle?
Will I have problems in the future with the ankle that I’ve sprained?
¿Cuál es el mejor medicamento analgésico para un esguince de tobillo?
 
 

How long will it take to recover fully from a sprained ankle?

Answer
How long it takes you to recover will depend on how severe your injury was. It can take between a few weeks and a year to fully recover from a sprained ankle.
 
Explanation
Mild sprains start to get better after a few days. Within six to eight weeks you should be able to put your full weight on your ankle without any pain when walking. If you still have pain after a week, it’s important to see your GP or a physiotherapist for advice.
 
If your sprain is mild, you can start doing some sport again once the swelling has gone down. This could be after a week for swimming but longer for activities that put more pressure on your ankle.
 
With more severe sprains your recovery period may take up to 12 months. It will also vary depending on whether or not you need an operation.
 
Unless you have a severe sprain and need to wear a cast or have surgery, the most effective way of treating most ankle sprains is to get moving quickly. This means starting to move your ankle and exercising it gently within 48 to 72 hours of your injury. Your GP or physiotherapist can advise you on exercises that will help to reduce the time it takes you to recover and prevent the injury happening again.
 

Will I have problems in the future with the ankle that I’ve sprained?

Answer
Most people have no long-term problems after a sprained ankle. However, if your sprain was very severe, it’s possible that your ankle will be permanently damaged.
 
Explanation
Around one in every three people with a severe ankle sprain goes on to have some lasting pain, swelling and stiffness. You may also find that your ankle feels less stable than it did before or as if it’s giving way, and you may go on to have more sprains. If these symptoms carry on for more than six months, it’s likely that you have a condition called ankle instability. This can be caused by many things such as damage to the nerves or bones in your ankle joint.
 
Ankle instability is usually treated first with physiotherapy. Special exercises and activities can help to retrain the nerves in your ankle and strengthen the muscles around your joint. Your physiotherapist may also recommend that you wear an ankle support or brace to help support your ankle.
 
If other treatments don’t work or if tests show that the ligaments around your ankle joint are torn, you will probably be referred to an orthopaedic surgeon who may suggest an operation.
 

What’s the best painkiller to use for a sprained ankle?

 Answer
This will depend on how much pain you have and how bad your sprain is. Your GP or pharmacist can give you advice.

Explanation
You can take paracetamol to help reduce pain and swelling. However, don’t take tablets that contain a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, or use creams or gels that contain NSAIDs until 48 hours after you injure your ankle. These will reduce inflammation, which is an important part of the healing process.
 
If your sprain is more severe, your GP can prescribe you a stronger painkiller that contains codeine phosphate. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.
 
If you have very severe pain or your pain doesn’t improve, see your GP or a physiotherapist.

Further information

British Orthopaedic Foot & Ankle Society
www.bofas.org.uk
 

Sources

  • Sprains and strains. National Institute of Arthritis and Musculoskeletal Diseases. www.niams.nih.gov, published April 2009
  • Bleakley C, O’Connor S, Tully M, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ Open 2010; 340:c1964. doi:10.1136/bmj.c1964
  • Ankle sprain. eMedicine. www.emedicine.medscape.com, published 22 September 2011
  • Sprains and strains. Prodigy. www.prodigy.clarity.co.uk, published July 2008
  • Wolfe MW, Uhl TL, Mattacola CG, et al. Management of ankle sprains. Am Fam Physician 2001; 63(1):93–105
  • Brukner P, Khan K. Clinical sports medicine. 2nd ed. North Ryde: McGraw Hill Australia, 2001:553–73
  • Ivins D. Acute ankle sprain: an update. Am Fam Physician 2006; 74(10):1714–20
  • Kerkhoffs G, Handoll H, de Bie R, et al. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults (Review). Cochrane Database of Systematic Reviews 2010, Issue 2. doi:10.1002/14651858.CD000380.pub2
  • Ankle instability. The British Orthopaedic Foot and Ankle Society. www.bofas.org.uk, accessed 26 September 2011
  • Sprained ankle. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2005
  • Anderson SJ, Harmon KG, Rubin A. Acute ankle sprains: keys to diagnosis and return to play. Phys Sportsmed 2002; 30(12):1–10. doi:10.3810/psm.2002.12.579
  • Norkus S, Floyd R. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train 2001; 36(1):68–73
  • Lynch S. Assessment of the injured ankle of the athlete. J Athl Train 2002; 37(4):406–12
  • Mark Evans J, Schucany W. Radiological evaluation of a high ankle sprain. Proc (Bayl Univ Med Cent) 2006(19):402–05

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