Quick answer: An ankle sprain is a stretch or tear of the ligaments that support your ankle, usually from rolling it inwards. Most people recover with a brace or tape, walking on it more as pain allows, and a programme of balance and strength exercises. Many feel better within 2 weeks, but a severe sprain can take 6 to 12 weeks or longer. Call 999 or go to A&E if you heard a crack, or if your ankle has changed shape or is numb, cold or a blue or grey colour.
What is a sprained ankle?
Ligaments are the strong bands of tissue that hold the ankle bones together. A sprain happens when they are stretched or torn, usually when you roll, twist or land badly on your foot.
- Rolling the foot inwards: the most common type. It injures the ligaments on the outside of the ankle.
- Rolling the foot outwards: less common. It injures the strong ligament on the inside of the ankle.
- High ankle sprain: an injury to the ligaments that join the two lower leg bones, often from the foot being forced to twist outwards.
Sprains are graded by how badly the ligament is hurt: grade 1 is a stretch, grade 2 is a partial tear and grade 3 is a complete tear.
Ankle sprains are one of the most common sports injuries. Sports with running, cutting and jumping, such as basketball, football and volleyball, carry a higher risk, and studies report higher rates in women than in men.
Symptoms
- pain, especially when you put weight on the foot
- swelling and bruising
- tenderness when you press on the injured area
- stiffness and difficulty moving the ankle
- the ankle feeling weak or unstable, especially after a severe sprain
Do I need an X-ray?
Usually not. Doctors use a checklist called the Ottawa ankle rules to decide. An X-ray is needed if you have pain in the ankle area and either:
- tenderness on the bone at the back edge or tip of either ankle bone, or
- you couldn’t take 4 steps straight after the injury, and still can’t when you are examined.
For pain in the middle of the foot, the check is tenderness at the base of the bone on the outside of the foot (the fifth metatarsal) or on the navicular bone on the inside, or not being able to take 4 steps. The rules were not designed for children under 18, so a child with an ankle injury should see a doctor.
Treatment for the first few days
- Support it: a brace or tape protects the ankle while it heals. A severe sprain may need a brace or cast for up to 10 days.
- Keep walking as pain allows: put more weight on the ankle as the pain settles. Long periods of complete rest are not needed for most sprains.
- Ice: wrap an ice pack in a towel and hold it on the ankle for up to 20 minutes every 2 to 3 hours.
- Raise it: rest it on a pillow when you sit or lie down to help the swelling go down.
- Pain relief: paracetamol, or ibuprofen gel on the ankle, are good first choices. Ibuprofen tablets can ease pain and swelling, but there is some concern that anti-inflammatories may slow the natural healing process. Ibuprofen, including the gel, may not be safe if you are pregnant, take a blood thinner such as warfarin, or have asthma, a stomach ulcer, or a heart, liver or kidney condition, so check with a pharmacist first.
Rehabilitation: getting the ankle strong again
Exercise is the most important part of recovery, and supervised exercise is preferred over passive treatments on their own. A physiotherapist will usually build your programme in stages:
- Movement: gentle ankle movements to ease stiffness.
- Strength: calf raises and resisted ankle movements.
- Balance: standing on the injured leg, then making it harder, for example with your eyes closed or on a cushion. Stand next to a worktop or wall you can hold if you need to.
- Sport skills: hopping, jumping, changing direction and running, before returning to full training.
Balance training also protects you from another sprain. In one trial in athletes, an 8 week home balance programme after a sprain cut repeat sprains over the next year from 33% to 22%.
Trail running after an ankle sprain
Uneven ground and steep downhill sections make it easy to roll an ankle on trails. There is no trail specific guideline for returning, so build up in steps: start on flat, even paths, then add gentle trails, and only then rough or technical ground. Keep doing your balance exercises, and wear a brace or tape while you rebuild confidence.
How long does a sprained ankle take to heal?
Most sprains feel better after about 2 weeks. Severe sprains can take 6 to 12 weeks or longer. Many people are back to sport within about 3 weeks, but return when you can hop, land and change direction on the injured leg without pain, not just when it stops hurting to walk.
Will it happen again?
It can. A previous sprain raises the risk of another, and in one study 40% of people developed ongoing ankle instability after a first sprain. The best protection is to complete your rehab, keep up balance training, and wear a brace or tape for sport in the months after the injury.
Do I need surgery?
Rarely. For the common outer ankle sprain, surgery is considered only if the ankle stays unstable or painful after a thorough exercise programme. Some high ankle sprains that leave the joint between the two leg bones unstable may need surgery sooner.
When to get medical help
Call 999 or go to A&E if you heard a crack when you were injured, or if the ankle has changed shape, is pointing at an odd angle, or is numb, tingling, cold or a blue or grey colour. Don’t drive yourself there.
See a doctor the same day if you can’t put weight on the foot or walk more than a few steps, if it is very painful, or if there is a lot of swelling or bruising. You may need an X-ray. Also see a doctor the same day if you have a high temperature or feel hot and shivery, as this could be an infection.
See a doctor the same day if the pain or swelling is getting worse. See a doctor or physiotherapist if it isn’t improving after a few days of treating it yourself.
Frequently asked questions
How long does a sprained ankle take to heal?
Most sprains feel better within about 2 weeks. A severe sprain can take 6 to 12 weeks or longer to recover fully.
Should I walk on a sprained ankle?
Yes, as much as pain allows, with a brace or tape for support. If you can’t take 4 steps, get it checked first, as you may need an X-ray. A severe sprain may need a brace or cast for a short time.
Do I need an X-ray for a sprained ankle?
Only if the Ottawa ankle rules point to a possible fracture, such as tenderness on the ankle bones or not being able to take 4 steps. Children should see a doctor.
How do I stop it happening again?
Finish your rehab, keep up balance exercises and wear a brace or tape for sport. These are the best supported ways to prevent another sprain.
Is it a sprain or a break?
It can be hard to tell. Tenderness on the bone, not being able to take 4 steps, or an ankle that looks out of shape are reasons to get it checked.
Sources
- NHS: Sprains and strains
- JOSPT 2021 clinical practice guideline: lateral ankle ligament sprains
- Vuurberg et al. 2018, BJSM: ankle sprain guideline update
- Hupperets et al. 2009, BMJ: home balance training after ankle sprain
- Ottawa ankle rules
- OrthoInfo (AAOS): Sprained ankle
- Herzog et al. 2019, Journal of Athletic Training: ankle sprain epidemiology
- NHS: Ibuprofen for adults
Need help with this? Our sports injury and running rehab team at Total Health by Hong Kong Sports Clinic can assess you and start treatment in your first session, in Central, Kai Tak or Tin Hau. Message us on WhatsApp to book.
