Most ankle sprains start to feel better within a few days of home care. You should get the ankle examined if you can't walk on it, if the pain isn't easing after ice, rest and pain medicine, or if it still doesn't feel better after 5 to 7 days. A sprain that keeps "giving way" weeks later also needs a look, because ankles that don't heal well tend to get sprained again.
Here's what a sprain is, how to care for one at home in the first couple of days, and the signs that mean it's time to call.
What happens when you sprain an ankle
Ligaments are the strong, fibrous tissues that connect bones to each other. A sprain happens when the ankle ligaments stretch past their limit and tear. Most sprains are the classic roll: the foot turns inward and the ligaments on the outside of the ankle take the strain. The American Academy of Orthopaedic Surgeons (AAOS) says around 90% of ankle sprains are this kind of inversion injury.
It doesn't take a sports injury. Stepping off a curb wrong, missing a stair or landing on uneven ground will do it. In Metro Detroit, the first icy mornings of the year bring plenty of them, in driveways and parking lots as much as on the field.
Doctors grade sprains by how badly the ligament is hurt:
- Grade 1: slight stretching and tiny tears in the ligament fibers
- Grade 2: a partial tear, often with some looseness in the joint
- Grade 3: a complete tear, with a lot of instability
Pain and swelling alone don't tell you how bad it is. AAOS notes that a severe sprain can cause as much pain, bruising and swelling as a broken bone, which is one reason an exam helps.
A less common type, the high ankle sprain, injures the ligaments that connect the two lower-leg bones just above the ankle. It can take much longer to heal than a typical sprain, so an ankle that hurts above the joint, or isn't improving, should be examined.
First 48 hours: caring for it at home
For a mild sprain, the usual home care is often called RICE.
Rest. Skip sports and anything that makes it hurt. You don't usually need to stay off it completely: MedlinePlus advises putting only as much weight on the foot as is comfortable at first, building up slowly, and stopping to rest if it starts to hurt. If you can't put weight on it at all, have it checked.
Ice. Put ice on as soon as you can, wrapped in a towel or bag rather than directly on the skin. MedlinePlus suggests 20 minutes at a time, every hour while you're awake for the first 24 hours, then 3 to 4 times a day after that, with at least 30 minutes between sessions.
Compression. An elastic wrap can help control swelling.
Elevation. Prop the ankle on a pillow at or above the level of your heart, especially in the first two days.
Pain and swelling from an ankle sprain often get better within 48 hours, according to MedlinePlus. If you'd like something for pain, ask your doctor or pharmacist which over-the-counter medicine is safe for you.
Signs you should be seen
Call the office if any of these are true:
- You can't walk on the ankle, or walking is very painful
- The pain isn't getting better with ice, rest and pain medicine
- The ankle doesn't feel any better after 5 to 7 days
- Swelling hasn't started to go down after a couple of days
- The ankle feels weak or keeps giving way
- You couldn't take four steps on it right after the injury, or the bony bumps on either side of the ankle (or the outer edge of the foot) are tender to press. Doctors use these signs, called the Ottawa ankle rules, to decide whether an X-ray is needed
- The ankle or foot is getting more discolored, or you notice numbness, tingling or coldness
- You keep spraining the same ankle
Go to urgent care or the emergency room instead if you think a bone may be broken, the joint looks out of place, the pain is severe, or you heard a popping sound and had trouble using the ankle right away. If you have diabetes or numbness in your feet, have any foot or ankle injury checked promptly, since you may not feel how serious it is.
What happens at the visit
At StepWell, Dr. Berry Byrd, DPM, starts by asking how the injury happened and then examines the ankle for swelling, tenderness, range of motion and stability. Not every sprain needs an X-ray. Imaging is used when the exam suggests a fracture or a more serious injury, and Dr. Byrd will explain why if one is recommended.
The American College of Foot and Ankle Surgeons notes that a sprain can come with other injuries that are easy to miss, which is part of the reason to have a significant sprain evaluated rather than waiting it out.
From there, the plan depends on what we find. You can read more about how we approach ankle sprains on the service page.
Why rehab matters more than people expect
Nearly all common (low) ankle sprains can be treated without surgery, AAOS says, even a complete tear, as long as it's protected and rehabilitated properly. The catch is the word "properly."
Once the pain settles, many people go straight back to normal and skip the exercises. That's understandable, and it's also the most common reason ankles stay loose. AAOS puts it plainly: incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain. Poor balance after a sprain often leads to repeat sprains, and repeated sprains can lead to long-term ankle pain and arthritis.
Rehab usually moves through stages: protecting the ankle and controlling swelling first, then getting range of motion and strength back, then balance work and a gradual return to sports or long walks. Balance exercises, like standing on the injured foot with the other foot raised, matter more than people think.
How long it takes depends on the sprain. AAOS says a minor sprain may need about 2 weeks of rehab, while a more severe one can take up to 6 to 12 weeks. Surgery is uncommon and is generally saved for ankles that don't respond to nonsurgical treatment or that stay unstable after months of rehab.
Lowering the odds of the next one
Strength, balance and flexibility are the best protection, according to AAOS. A few practical steps help:
- Keep doing your balance exercises after the ankle feels normal
- Warm up before sports and exercise
- Wear shoes with the right support for the activity, and winter boots with real tread once the ice arrives
- Take extra care on uneven ground, wet leaves and icy pavement
If your feet roll in a lot or your arches ache after activity, flat feet may be part of the picture, and that's something we can look at too.
If your ankle isn't improving, or this is your second or third sprain on the same side, call StepWell at (248) 559-5200 or book a visit. We see patients Monday, Wednesday and Friday, 9:00 to 5:00, at 17515 West 9 Mile Rd., Suite 950, in Southfield.
Sources
- American Academy of Orthopaedic Surgeons, OrthoInfo, Sprained Ankle (opens in a new tab)
- American College of Foot and Ankle Surgeons, FootHealthFacts, Ankle Sprain (opens in a new tab)
- MedlinePlus, Ankle sprain: aftercare (opens in a new tab)
- MedlinePlus, Sprains (opens in a new tab)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Diabetes and Foot Problems (opens in a new tab)
- American Family Physician, Update on Acute Ankle Sprains (Ottawa ankle rules) (opens in a new tab)
This article is general information, not medical advice. For an injury, call the office or see a doctor.