Sprained ankle

Published by Bupa's Health Information Team, January 2010.

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

A sprained ankle occurs when a ligament is injured through stretching or a sharp pull. Ligaments are strong bands of tissue that connect one bone to another and help to hold joints together.

About sprained ankles

A sprained ankle, or twisted ankle, is the most common type of soft tissue injury. Soft tissue means any tissue in your body that isn't bone. Around 1.5 million people go to UK accident and emergency departments each year with severe sprained ankles.

A minor sprain is when a ligament is stretched or partially torn. In severe sprains the ligament is completely torn. Sometimes the end of the bone to which a ligament is attached can crack or be pulled off. This is called an avulsion fracture.

Symptoms of a sprained ankle

When you sprain your ankle there is sometimes a snapping or popping sound and a feeling of 'giving way' - this could be a ligament tearing or a bone cracking. A sprain can be very painful with the pain getting worse when you move your ankle. With a severe sprain you may not be able to put weight on your leg.

You may have swelling and bruising. Swelling happens soon after the injury but bruising can take up to 24 hours to fully develop. The swelling around your ankle can make it difficult to move your foot and your ankle may feel unstable.

Causes of a sprained ankle

The most common type of ankle sprain is when the sole of your foot turns inwards, overstretching the ligaments on the outside of your ankle and squeezing those on the inside. This is called an inversion sprain.

Ankle sprains make up about a quarter of all sporting injuries. They are especially common in sports that involve running and jumping, landing from a jump, changing direction quickly, or lots of stop-starts.

Other causes include:

• walking on irregular surfaces
• your foot slipping off the edge of a kerb
• slipping while going up or down stairs
• losing your balance while wearing high heels

You're more likely to sprain your ankle if it has happened before.

Diagnosis of a sprained ankle

Whether or not you need medical treatment will depend on how severe your symptoms are.

Your GP will ask about your symptoms and examine your ankle to see how bad the sprain is. He or she will ask how the injury happened and also get you to try to walk.

You may have an X-ray if your GP suspects that a bone has been damaged and will need specific treatment.

Treatment of a sprained ankle

The treatment you receive will depend on how severe your injury is.

Self-help

Follow the PRICE procedure as soon as possible after injuring your ankle. PRICE stands for the following.

• Protection. Protect your ankle from further harm, for example, by using a support or high-top, lace-up shoes.
• Rest. Try to rest your injury for the first 48 to 72 hours. Use crutches to help you get around if you need to. After this time, gradually re-introduce movement to the affected area.
• Ice. Apply ice packs or ice wrapped in a damp towel for 15 to 20 minutes every two to three hours. Never apply ice directly to your skin as it can give you an 'ice burn' - always place a cloth between the ice and skin. If you have no ice to hand, you could also use a bag of frozen peas or immerse the area in iced water. This will help to reduce any swelling and bruising. You should try to apply ice for the first 48 to 72 hours after your injury but only when you're awake - never leave ice on while you sleep. Also, don't use ice if you have skin disorders that make your skin sensitive.
• Compression. Compress the area by bandaging it to support the injury and help decrease swelling. You can use a simple elastic bandage to do this or an elasticated tubular bandage. It should fit snugly but not be too tight. Make sure you remove the bandage before going to sleep.
• Elevate. Elevating your ankle above the level of your heart will help to control the swelling. Use a pillow to keep the area raised. Try to keep it elevated as much as possible until the swelling goes down.

It's important to begin gentle flexibility exercises within 48 to 72 hours of injury as long as it doesn't cause excessive pain - this will help your injury to heal more quickly. It will also help you regain the full range of motion in your ankle.

You could try the following exercises.

• Move your foot up and down as though pressing on a car pedal.
• Make circles with your foot, both clockwise and anti-clockwise.
• In either a sitting or a standing position, shift your weight from front to back and from the inside to the outside of your foot.
• Stretch your Achilles tendon (without putting weight on it) - you can do this by using a belt to pull your toes up towards you.

It's important to see your GP or a physiotherapist if:

• you can't walk more than four steps on the affected ankle immediately after you injure it
• your ankle remains extremely painful or swollen after four days of self-treatment
• you have a lot of pain, redness or swelling over a bony area of your foot
• you have lumps and bumps that aren't usually there
• your ankle feels numb

If possible, see a physiotherapist who can advise you on exercises to restore the range of movement in your ankle. Your risk of injuring your ankle again is very high if you don't get the correct treatment.

Medicines

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.

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

Surgery

Surgery to treat a sprained ankle is rare and usually only done if your ankle remains unstable. Surgery can repair torn ankle ligaments, but there isn't enough evidence to say whether this is better than keeping your ankle in a cast, or keeping your ankle moving and wearing a support brace. Your doctor may recommend surgery for torn ankle ligaments that aren't getting better.

After your treatment

Following a sprain or a strain, the length of time that it takes for you to recover will depend on how severe your injury was. The pain and swelling should begin to subside after a few days. At this point, try to move your ankle more than you have been able to. If you're using a brace or taping, take this off after two days because it limits movement. Instead use a compression bandage that doesn't restrict movement as much.

Exercises to strengthen your muscles are important because they will help your recovery. They will also make your ankle more stable, helping to prevent another injury. Try to increase how far you move your ankle each day but take care not to cause more pain.

There is evidence suggesting that a below-knee cast or brace worn for 10 days for a severe sprain may speed up the healing process compared with an elasticated bandage that allows movement.

The time it takes for you to recover fully will depend on the severity of your injury.

Prevention of a sprained ankle

There are measures you can take to help reduce your risk of spraining your ankle again.

• A brace or taping can support your ankle in the short term if your injury is severe but try to strengthen the muscles around your ankle through exercise to give it more long-lasting support. See a physiotherapist as soon as possible after injuring your ankle to get advice about the sort of exercises that will help.
• Wear footwear that supports your ankle.
• Don't wear shoes that are worn on one side and take care when wearing high heels.
• Try to keep stairs and hallways clear.
• Don't exercise if you're tired - your muscles will be tired too and offer less support to your joints. Injuries can occur as a result of being tired from playing sport or doing strenuous activity.
• Do strength and endurance training before the season begins if you're a competitive sportsperson.
• A recent study showed that doing balancing exercises can cut your risk of spraining your ankle again. A physiotherapist can advise you on these and how to advance them as your ankle gets stronger.

Video

See our video about sprained ankle:

• Treating sprains and strains

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

For sources and links to further information, see Resources.