Sprained ankle

A sprained ankle is a common type of ankle injury. It can happen if you twist or turn your foot beyond its normal range of movement. This can stretch or tear the ligaments that support your joint. A sprained ankle can be very painful. But most ankle sprains heal well.

About sprained ankle

You can sprain your ankle in different ways. It’s most likely to happen if you suddenly twist your foot too far inwards (an inversion sprain). This can make the ligaments on the outside of your ankle stretch past their normal range and sometimes tear.

Ligaments are bands of fibrous tissue that connect one bone to another. They support your joint and prevent specific movements between two bones. You can sometimes sprain more than one ankle ligament. Occasionally, a sprain can affect the bones around your ankle joint too.

Sprained ankle grades

Sprained ankles can be graded to describe how severe the injury is.

• Grade 1. A mild sprain, which happens when you overstretch a ligament. You may have mild swelling, bruising, and pain around your ankle. But you should be able to put some weight on your foot.
• Grade 2. A moderate sprain, which happens when you overstretch and partially tear a ligament. You may have quite a lot of swelling, bruising, and pain around your ankle. You may also find it difficult to put weight on your foot.
• Grade 3. 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 wobbly (unstable). You won’t be able to put any weight on your foot without a lot of pain.

What causes a sprained ankle?

You may sprain your ankle when doing sports. This is most likely to happen in sports involving sudden changes in direction or where you may jump and land awkwardly. These include:

• football
• basketball
• volleyball
• climbing

But ankle sprains aren’t always linked to sport – you can sprain your ankle doing everyday activities too.

If you’ve sprained your ankle before, you’re more likely to do it again. This is because your ankle ligaments may be weaker, even after they’ve healed. This is more likely to happen if you haven’t done any strengthening or balancing exercises during your recovery.

Some other things can increase your risk of spraining your ankle, such as:

• if you’re new to a sport or haven’t trained properly and your technique is poor
• not warming up or cooling down after you exercise
• wearing unsuitable footwear, which may make you more likely to go over on your ankle
• not exercising regularly, which means your muscles and joints may be weaker and more prone to injury
• If you have poor co-ordination or balance
• if you’re overweight or underweight

Symptoms of a sprained ankle

Sprained ankle symptoms will depend on how severe your injury is. These may include:

• pain
• swelling
• bruising
• limping
• restricted movement
• stiffness after rest
• difficulty putting weight on your foot, or more pain when you do
• your ankle feeling unstable and wobbly when you try to stand on it

When should I seek medical help?

You don’t always need to seek medical help for ankle sprain symptoms. You can usually treat a mild ankle sprain by following some self-care measures at home (see our self-help for a sprained ankle section). But if your sprain is severe, you may need medical attention. It’s possible you may have damaged other parts of your ankle such as the bones or tendons. It can be difficult to know if you have a very severe sprain or a broken bone (fracture) without an X-ray.

Seek medical attention straight away if:

• your ankle is too painful to stand on
• your ankle seems deformed
• your skin is broken

You can usually go to an urgent treatment centre or minor injury unit for ankle sprain treatment, but phone NHS 111 if you’re not sure. You should also see a physiotherapist if the pain and swelling don’t improve within a week or get worse after a few days. Your GP may be able to refer you to a physiotherapist on the NHS. Or you may be able to refer yourself on the NHS or pay for a private physiotherapy appointment.

If you keep spraining your ankle or it feels unstable, make an appointment to see a GP or a physiotherapist.

Diagnosis of a sprained ankle

A doctor or physiotherapist will usually be able to diagnose a sprained ankle by asking about your symptoms and examining you. They’ll ask exactly how you hurt your ankle and if you could stand and walk afterwards. When they examine you, they’ll check for pain, swelling, and bruising around your ankle. They may also check how much you can move your ankle and if you can put any weight on your foot.

If your injury is particularly severe, your doctor or physiotherapist may recommend you have an X-ray to check whether or not your ankle is broken. They may also arrange an ultrasound or MRI scan. But these tests aren’t often used to diagnose an ankle sprain.

Ask a physiotherapist or pharmacist for the best type of support or splint to use. You can also use crutches if you need to.

You can use the word HARM to remind yourself of things you should avoid doing in the first three days after your injury.

• H – Heat. Don’t have hot baths, showers, or saunas – and avoid heat packs and rubs.
• A – Alcohol. Drinking alcohol can slow down your recovery and mask your symptoms – increasing the risk that you’ll injure yourself again.
• R – Running. Don’t run or do any other form of moderate exercise. This can delay your ankle healing.
• M – Massage. Massaging the affected areas can cause more swelling and damage.

Treatment of a sprained ankle

Sprained ankle treatment aims to:

• reduce pain
• reduce swelling
• get your ankle back to its usual range of movement as soon as possible
• improve your muscle strength
• improve the way your muscles and nerves work together (to help with things like your balance)

Medicines for a sprained ankle

You can take over-the-counter painkillers such as paracetamol or ibuprofen to help ease your ankle pain. You can get ibuprofen gels that you put on the skin over your ankle. If over-the-counter painkillers don’t help, your doctor may offer you a prescription for stronger pain relief. Always read the patient information that comes with your medicine. If you have questions, ask a pharmacist or doctor for advice.

Exercise and movement for a sprained ankle

You may need to briefly rest your ankle after you injure it, usually for two to three days. But it’s usually best to start moving it again and do some gentle exercises as soon as you can. This will help your ankle to get back to normal more quickly than if you keep it still (unless you have a severe sprain). Your doctor or physiotherapist may give you something to protect your ankle while you move it, such as a brace or splint.

If you have a particularly severe sprain, your doctor or physiotherapist may advise you to wear a cast, splint, or brace to stop your ankle from moving (immobilise it) for a few days. This may help to reduce any pain and swelling around your ankle. They’ll advise you when to start moving and exercising your ankle again.

If you’re at all worried about doing exercises, or feel any pain, stop and speak to a doctor, nurse, or physiotherapist before you continue. If you’re not sure when and how to start exercising your ankle, check with a doctor or physiotherapist.

Physiotherapy for a sprained ankle

You don’t always need physiotherapy for a sprained ankle. But if your sprain is very severe or isn’t getting better after a week or so, physiotherapy may help. You may be able to book an appointment with a physiotherapist directly, without needing to see your GP (self-referral). Ask at your GP surgery to see whether or not this is available in your area.

A physiotherapist can develop an exercise programme for you. This will include exercises to improve your range of movement, strength, balance, and neuromuscular (muscle and nerve) control. The programme will involve co-ordination exercises and balance training. It will aim to build your strength and mobility while getting back the full range of movement in your ankle.

It’s important to stick to your physiotherapist’s exercise plan. This will help to make sure your ankle is back to full strength before you return to any sports or high-impact activities. You’re less likely to sprain your ankle again if your ankle has fully recovered and you have a full range of movement and strong muscles again.

Surgery for a sprained ankle

It’s unlikely you’ll need to have surgery for a sprained ankle. But if your ankle is severely sprained or isn’t getting any better, your GP may refer you to see an orthopaedic surgeon. They’ll advise you whether or not surgery may be helpful. You’re more likely to need surgery if you’re an athlete at a professional level.

Prevention of a sprained ankle

There are things you can do to reduce your chances of spraining an ankle or injuring it again after you’ve recovered. This includes keeping the muscles around your ankle as strong and as flexible as possible.

Other things you can do for ankle sprain prevention include the following.

• Wear shoes that are in good condition, and are suitable for the activity you’re doing and where you’re doing it.
• Try to do some exercises that include strength, balance, and flexibility training, as well as cardiovascular fitness. And make sure you have days off from doing intense exercise.
• Take care when you walk or run on uneven surfaces – exercise on even surfaces if you can, or wear supportive footwear.
• Warm up and stretch your muscles before you play sport, and cool down afterwards.
• During certain activities, it may help to wear an ankle brace or ankle tape, especially if you’ve had a previous injury.
• Maintain a healthy weight – sprains are more likely if you’re very overweight or underweight.