Types of sprained ankle
Sprained ankles are grouped into three grades, according to how severe the injury is. These are explained below.
- A grade I sprain is a mild sprain, which happens 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.
- A grade 2 sprain is a moderate sprain. It happens when you overstretch and partially tear a ligament. You may have quite a lot of swelling, bruising and pain around your ankle, which may feel a little unstable. You may find it difficult to put weight on your foot.
- A grade 3 sprain is a severe sprain, which happens when you completely tear a ligament. The swelling, bruising and pain around your ankle are usually severe. Your ankle may feel quite unstable and you won’t be able to put any weight on your foot without feeling extreme pain.
Symptoms of a sprained ankle
The symptoms of a sprained ankle you have will depend on how severe your injury is. Your symptoms may include:
- restricted movement
- difficulty putting weight on your foot
- instability of your ankle
- a popping or tearing sound at the time of your injury
Diagnosis of a sprained ankle
If you have only mild symptoms, you may decide for yourself that you have a sprained ankle and so don’t seek medical attention. See our treatment section on self-care below, and our FAQ on ‘When do I need to see a doctor?’
Many people with a sprained ankle choose to go to the hospital emergency department. Alternatively, you may decide to visit a community or sports physiotherapist, or attend your doctor’s surgery (to see a GP or nurse practitioner). For simplicity, we’ll just refer to ‘your doctor’ below, but this includes these other healthcare professionals.
Your doctor will ask about your symptoms. They’ll also ask you to describe exactly how you injured your ankle and whether you could stand and walk afterwards. They may ask you about your medical history and whether you’ve had similar problems with your ankle before.
Your doctor will examine you; checking 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.
Your doctor will usually be able to diagnose a sprained ankle on the basis of what you tell them, and on what they find when they examine you.
You may need an X-ray if your doctor thinks your injury is severe. This is because you may need more specific treatment, for instance for a fracture (broken bone). Your doctor will usually recommend you have an X-ray if:
- you can’t put weight on your foot for four steps
- they think you may have a fractured (broken) bone, for example, if your bone (rather than the ligament) is tender
Treatment of a sprained ankle
Treatment for a sprained ankle aims to reduce the pain and swelling, and to make sure your ankle can maintain or get back to its usual range of movement as soon as possible. It can be frustrating, but it may take several months to recover from a sprained ankle. In some cases it may be a year or more. So you may need to be patient, and follow treatment advice carefully.
If you have a sprained ankle, there’s a lot you can do to ease your symptoms in the first few days. If you see a doctor, nurse or physiotherapist, they’ll probably advise you to follow the advice given below.
You can take over-the-counter painkillers, such as paracetamol, to help relieve the pain of your sprained ankle. Your doctor may offer you a prescription for codeine in addition to paracetamol. Forty-eight hours after your injury, your doctor may also suggest you use ibuprofen to help reduce the swelling around your sprained ankle. It’s best not to use ibuprofen and other similar medicines in the first two days after your injury as they may delay healing.
Ibuprofen and other similar medicines are also available in forms that you put directly onto your skin (topical medicines). These are OK from the time of injury and may help relieve your pain.
Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.
Exercise and movement
The right time to start exercising your ankle may depend upon how severely it’s been injured.
When your pain isn’t too bad, start doing some gentle exercises. These may help prevent stiffness and will eventually get your ankle moving normally.
If you have a severely sprained ankle, your doctor may advise you to immobilise it. This means to keep your ankle still, and will probably only be for a short period of time (up to 10 days). They may also advise you to wear a below-knee cast or brace. Wearing a cast or brace may help to reduce the pain and swelling around your ankle quicker than a compression bandage.
If you’re at all unsure about when and how to start exercising your ankle, ask your doctor, nurse or physiotherapist and follow their advice.
If your sprained ankle is more severe, you may benefit from 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. It’s important to keep to the exercise plan that your physiotherapist recommends.
It’s very rare for a person with a sprained ankle to have surgery. Doctors aren’t yet sure whether surgery is better than non-surgical treatments for severe ankle sprains. If your ankle is severely sprained, or remains unstable and prone to repeated sprains, it’s possible your doctor may recommend surgery. Surgery is most likely to be used for high performance sportsmen and sportswomen.
If your ankle continues to cause you pain and is not responding to treatment, your doctor may refer you to an orthopaedic surgeon (a doctor who specialises in bone surgery).
Recovering from a sprained ankle
It can be frustrating, but it’s best to be prepared for it to take several months before you’re back to normal activities after spraining your ankle. Most ankle sprains get better completely and cause no long-term problems.
The length of time it actually takes you to recover will depend on how severe your sprain is (see ‘Types of sprained ankle’ above).
If you have a mild sprained ankle, you may be able to walk within the first two weeks after your injury. You may be able to fully move your ankle without any pain within six to eight weeks. You can probably go back to playing sport within eight to 12 weeks.
If you have a moderately sprained ankle, it may take you two to three months to recover.
A severely sprained ankle can take between eight and 12 months to recover. However, some people with a severe sprain have permanent damage to their ankle which may remain unstable and painful.
Ask your doctor or physiotherapist when you can safely take up your normal activities again, including sports. If you start too soon, you may injure the area again and this may lead to long-term problems with your ankle.
If you’re concerned about how long your ankle is taking to recover, or your symptoms get worse, speak to your doctor or physiotherapist.
Causes of a sprained ankle
You’re most likely to sprain your ankle when your foot twists suddenly so that your sole is facing too far inwards. This is known as an inversion sprain. Twisting too far can make the ligaments on the outside of your ankle stretch past their normal range. Some of the ligament fibres may tear, or the ligament itself may be completely torn. Sometimes more than one ligament is affected, and occasionally small pieces of bone may tear off too.
A sprained ankle may be caused by a number of different things:
- an accident caused by walking on an uneven surface
- a sudden change in direction while playing sport
- landing awkwardly from a jump
You may be more likely to sprain your ankle if you haven’t trained properly or you’re very inexperienced with a new sport or activity.
If you’ve sprained your ankle before, you’re more likely to do it again. This may be because the ligaments didn’t heal properly the first time and so they’re weaker. Up to one in three people who’ve sprained their ankle may get another sprain within three years of the first injury.
Prevention of a sprained ankle
There are a number of things you can do to lessen the chance that you’ll get 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 things are listed below.
- Wear shoes that fit and are appropriate for the activity you’re doing.
- If you’re tired, try not to play any sports or exercise.
- Take care when walking or running on uneven surfaces – exercise on even surfaces if you can.
- Warm up and stretch your muscles before playing sport.
- Wearing high top shoes, an ankle brace or ankle tape may provide you with some support and prevent further injuries when doing certain activities.
- Stay a healthy weight for your height – sprains are more likely if you’re obese.
When should I see a doctor?
You can usually treat a mild sprain with self-care at home. However, more severe sprains may need medical attention. You might also have damaged other parts of your ankle such as the bones or tendons.
Seek medical attention right away if your ankle is too painful to bear your weight, it seems deformed or your skin is broken. You should also have your ankle checked out if the pain and swelling get worse rather than better over the first three to four days.
And always see a doctor if your ankle was injured in an accident where there was a large force involved. This might include a fall from a height or a blow from a heavy object.
How long will it take to fully recover from a sprained ankle?
The length of time it takes for you to recover from a sprained ankle will depend on how severe your sprain is. Mild sprains may take up to eight weeks to fully recover, while moderate sprains may take a month or so longer. If you have a severe sprain, it may take around a year, or even more for you to recover. See our section on recovery from a sprained ankle above for more information.
Ask your doctor or physiotherapist how long they’d expect recovery to take in your circumstances. If you want to start or resume sports or other physical activities, check with them when and how you can safely do this.
Will I have problems in the future with the ankle that I've sprained
Most people make a full recovery after spraining an ankle. However, if you’ve sprained your ankle in the past, you may sprain it again if the ligaments have not healed properly. And unfortunately, if you’ve had a severely sprained ankle, it may leave you with some permanent damage.
If your sprained ankle doesn’t heal properly or is left untreated, or you rush back to normal activities too soon, you may sprain it again. Or you may be left with permanent damage from the original sprain. Long-term problems after a sprained ankle may include:
- chronic pain – pain that lasts a long time
- chronic instability – when your ankle remains unstable for a long time
- loss of balance
- muscle weakness
Following your injury, it’s important to begin gentle exercises when you can, as these prevent stiffness and keep your ankle moving. Exercise, together with things such as an elastic support, ankle tape or a brace may help to protect your ankle from further sprains.
After completing your treatment, if your sprained ankle doesn’t improve or your symptoms get worse, seek advice from your doctor or physiotherapist.
My doctor told me I have a high ankle sprain - what's that?
A high ankle sprain is an uncommon type of ankle sprain, seen most often in people doing contact sports and in skiers. In these sprains the ligament lying between your two lower leg bones becomes stretched or torn. High ankle sprains take longer to heal than the more usual type of ankle sprain. Your doctor will explain your treatment, which may include wearing a fracture boot or short leg cast.
Your lower leg is made up of two bones: the tibia and fibula. A ligament, called the syndesmotic ligament, holds the lower end of these bones together and helps support your ankle joint. If you have a high ankle sprain (also called a syndesmotic sprain), this ligament may become stretched or torn. This may happen if your lower leg and foot twist too far up and outwards. Only one in ten people who sprain their ankle have this type of injury.
If you have a high ankle sprain, you may feel pain at the front of your lower leg and when you move your foot outwards. This area may be tender to touch.
High ankle sprains are harder to diagnose and have a longer recovery time than the more usual type of ankle sprains.
Your doctor or physiotherapist will explain what treatment is recommended if you have a high ankle sprain. You may need to wear a fracture boot or short leg cast if your ankle is unstable.
Other helpful websites
- British Orthopaedic Foot & Ankle Society
- Musculoskeletal sprains and strains. BMJ Best practice. bestpractice.bmj.com, published 7 December 2015
- Ankle sprain. Medscape. www.emedicine.medscape.com, published 3 January 2016
- Ankle injuries. PatientPlus. www.patient.info/patientplus, published 19 January 2012
- Ankle sprains. Merck. www.merckmanuals.com, reviewed December 2014
- Sprains and strains. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published April 2015
- Map of Medicine. Ankle injury. International View. London: Map of Medicine; 2013 (Issue 1)
- Derry S, Moore A, Gaskell H, et al. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 6. doi:10.1002/14651858.CD007402.pub3
- 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. Cochrane Database of Systematic Reviews 2007, Issue 2. doi:10.1002/14651858.CD000380.pub2
- Physiotherapy and football injuries. Chartered Society of Physiotherapy. www.csp.org.uk, published June 2014
- Ankle instability. British Orthopaedic Foot and Ankle Society (BOFAS). www.bofas.org.uk, accessed 27 January 2016
- Sprained ankle. American Academy of Orthopaedic Surgeons (AAOS). www.aaos.org, accessed 27 January 2016
- Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull 2011; 97(1):105–35. doi:10.1093/bmb/ldq028
- Sprains and strains. National Institute of Arthritis and Musculoskeletal and Skin Diseases. www.niams.nih.gov, published January 2015
- Molinari A, Stolley M, Amendola A. High ankle sprains (syndesmotic) in athletes: diagnostic challenges and review of the literature. Iowa Orthop J 2009; 29:130–38
- Williams G, Allen E. Rehabilitation of syndesmotic (high) ankle sprains. Sports Health 2010; 2(6):460–70. doi:10.1177/1941738110384573
- High ankle sprain. American Orthopaedic Foot & Ankle Society. www.aofas.org, accessed 27 January 2016
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