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Sprained ankle

Key points

  • A sprained ankle may occur when a ligament around your ankle becomes injured. It may be caused by an accident due to walking on an uneven surface.
  • Symptoms of a sprained ankle may include pain, swelling and bruising.
  • If you have a sprained ankle, it’s important you follow PRICE (protect, rest, ice, compression, elevate) and avoid HARM (heat, alcohol, running and massage).

A sprained ankle may occur when a ligament around your ankle joint becomes injured. A ligament is a fibrous tissue that connects one bone to another at a joint.

About sprained ankles

A sprained ankle is a very common musculoskeletal injury. It can happen when your foot twists or rolls beyond its normal motion. This can stretch or tear the ligament that supports your joint.

Illustration showing the bones and ligaments of the ankle joint

Symptoms of a sprained ankle

Symptoms of a sprained ankle will depend on how severe your injury is. The symptoms associated with a sprained ankle include:

  • pain
  • swelling
  • bruising
  • restricted movement
  • limited ability to put weight on your foot
  • a popping or tearing sound at the time of your injury

Type of sprained ankles

Sprained ankles are grouped into three grades, which are explained below.

Grade I

A grade I sprain is a mild sprain, and may occur when you overstretch a ligament. You may have minor swelling, bruising and pain around your ankle, but you should be able to put some weight on your foot.

Grade II

A grade II sprain is a moderate sprain. It may occur when you overstretch and partially tear a ligament. The swelling, bruising and pain around your ankle may be moderate. You may find it difficult to put weight on your foot.

Grade III

A grade III sprain is a severe sprain, and may occur when you completely tear a ligament. The swelling, bruising and pain around your ankle is usually severe. You won’t able to put any weight on your foot without feeling extreme pain.

Complications of a sprained ankle

If your sprained ankle doesn’t heal properly, is left untreated or you rush back to normal activities too soon, your ankle may feel unstable. If this happens you’re at risk of spraining your ankle again.

See our FAQ for more information about complications of a sprained ankle.

Causes of a sprained ankle

A sprained ankle most commonly happens when your foot twists inwards. This can make the ligaments on the outside of your ankle stretch past their normal range. This is known as an inversion sprain.

A sprained ankle may be caused by a number of different things, such as:

  • an accident caused by walking on an uneven surface
  • a sudden change in direction while playing sport
  • landing awkwardly from a jump

You may sprain your ankle if you have done so previously. This may be because the ligaments didn’t heal properly the first time and so they are weaker.

Diagnosis of a sprained ankle

You may see different people about your sprained ankle. Some people often go to the emergency department of a hospital, rather than their doctor’s surgery. At the hospital, medical staff may advise you about your treatment. If you see your doctor at your doctor’s surgery, he or she may treat you or refer you to a physiotherapist.

Your doctor or nurse will ask about your symptoms and examine you. They may also ask you about your medical history and to describe exactly how you injured your ankle.

Your doctor or nurse may check for any pain, swelling and bruising you might have around your ankle. They may also want to see how much you can move your ankle and whether you can put any weight on your foot.

You may need an X-ray if your doctor or nurse thinks your injury is severe, as you may need more specific treatment. An X-ray is usually carried if:

  • you can’t put weight on your foot
  • your doctor or nurse thinks you have a fractured (broken) bone

Treatment of a sprained ankle

It’s important that you begin to treat your sprained ankle as soon as possible. This may help to speed up your recovery.

You may see different people about your treatment. Some people may go to emergency department of a hospital, rather than their doctor’s surgery.

Self-help

In the first 48 to 72 hours after your injury, it’s important to follow the PRICE procedure. Many minor sprains will respond well to this. This procedure is described below.

  • Protect your ankle from further harm. You can use things such as an elastic support, ankle tape or a brace to protect your ankle.
  • Rest your ankle 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 it.
  • Compress your ankle by bandaging it. This will help to support your sprained ankle and reduce swelling. The bandage should fit snugly but not be too tight, and you should remove it before going to sleep.
  • Elevate your sprained ankle 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.

For the first 72 hours after your injury, there are certain things you shouldn’t do. These can be remembered using HARM, which is described below.

  • Heat. Don’t use heat packs, hot water bottles or heat rubs on your sprained ankle, and steer clear of saunas and hot baths. Heat encourages blood to flow to the area, which is the opposite effect of using ice.
  • Alcohol. Don’t drink alcohol because it can increase bleeding and swelling around your ankle, slowing down the healing process.
  • Running or any other form of strenuous exercise. Such activities are likely to cause more damage.
  • Massage. This can increase bleeding and swelling.

Medicines

Over-the-counter painkillers, such as paracetamol, can be used to help relieve the pain of your sprained ankle. Your doctor may prescribe you codeine in addition to paracetamol. 48 hours after your injury, your doctor may also suggest you use ibuprofen to help reduce the swelling around your sprained ankle.

Exercise

As you feel that your pain is tolerable, start doing some gentle exercises. These may help prevent stiffness and will get your ankle moving in all normal directions.

Hospital treatment

If you have a severely sprained ankle, your doctor may advise you to immobilise your ankle (keep your ankle still) for a short period of time (up to ten days). They may also advise you to wear a below-knee cast or brace. Evidence suggests that wearing a cast or brace may help to reduce the pain and swelling around your ankle quicker than a compression bandage.

Physiotherapy

If your sprained ankle is more severe, you may need physiotherapy. This aims to keep your ankle moving, prevents stiffness, and strengthens the muscles and joint around your ankle. All of these things mean you’re less likely to sprain your ankle again. Your physiotherapist may ask you to focus on building your strength and mobility through co-ordination exercises and balance training. You may find physiotherapy helpful; however, there isn’t enough evidence to say how effective it is for a sprained ankle.

Surgery

If your ankle is severely sprained, you may need surgery. However, there isn’t enough evidence to suggest that surgery is more effective than physiotherapy and exercise.

If your ankle is still causing you pain and is not responding to treatment, your doctor may refer you to an orthopaedic surgeon (a doctor who specialises in bone surgery).

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.

See our FAQs for more information about recovering from a sprained ankle.

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 and flexibility 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.
  • Stay a healthy weight for your height.
  • Eat a healthy, balanced diet – this will help to keep your muscles strong.
  • Take care when walking or running on uneven surfaces.
  • Warm up and stretch your muscles before playing sport.
  • If you’re taking part in a sport, ensure that you wear protective clothing if you need it.
  • Try to do stretching exercises every day.
  • If you’re tired, try not to play any sports or exercise.
  • Wearing high top shoes, an ankle brace or ankle tape may provide you with some support and prevent further injuries when doing certain activities.

 

Reviewed by Kuljeet Battoo, Bupa Health Information Team, March 2014.

Find out more about our health editors.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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