Ankle Sprains: What Happens, Home Care and When to Get Checked

One wrong step on a rocky trail, a slick patch of ice on the sidewalk, or an awkward landing on the court, and your ankle rolls. Ankle sprains are "very common injuries" and "among the most common sports injuries."⁴ Many heal well with good home care. But some sprains are more serious than they first look, and a sprain that isn't given time to recover can leave the ankle weak and prone to giving way.^1,2

Here's what happens when you sprain an ankle, how to care for it, and when to get it checked.

What Actually Happens When You Sprain Your Ankle?

Your ankle bones are held together by ligaments, which are strong bands of tissue. A sprain happens when those ligaments get stretched too far.⁴ Depending on the injury, a ligament may be stretched, partly torn or completely torn, and more than one ligament can be hurt at once.¹

Most sprains affect the ligaments on the outside of the ankle.^1,6 The usual cause is the foot rolling inward under the leg, which doctors call an inversion injury.^3,6 Common triggers include falls, sudden twists, sports, poorly fitting shoes and uneven ground.¹ If you've had a weak ankle or a sprain before, you're more likely to sprain it again.¹

Typical symptoms include pain (especially with weight on the foot), swelling, bruising, stiffness and trouble walking.^1,4

What Do the "Grades" of a Sprain Mean?

Sprains are usually sorted into three grades based on how badly the ligament is damaged:^3,4,5

• Grade 1 (mild): The ligament is stretched, with slight or microscopic tearing. There's some pain and tenderness, but you can usually walk on it.
• Grade 2 (moderate): The ligament is partly torn. Expect more swelling, pain when walking and some feeling that the ankle is unstable.
• Grade 3 (severe): The ligament is completely torn. Swelling is significant, putting weight on the foot is very painful or impossible, and the ankle may feel loose.

Recovery time varies with the grade. Cleveland Clinic says mild sprains usually heal in a week or two, while a complete tear "can take up to several months" to recover.⁴ AAOS gives a similar range: about 2 weeks for minor sprains and 6 to 12 weeks for more severe ones.³

How Should I Care for a Sprain at Home?

For years the standard advice has been RICE: rest, ice, compression and elevation.^1,3 A clinical review in StatPearls describes the evidence-based approach as the POLICE principle instead: protection, optimal loading, ice, compression and elevation.⁶

• Protect and rest it. Stay off the ankle at first.¹ A brace, wrap or splint can help, and crutches may be suggested for higher-grade sprains.⁴
• Ice it. StatPearls notes that cold therapy in the early stage "is supported by strong evidence for improving short-term outcomes."⁶ Sources give slightly different schedules. MedlinePlus suggests ice every hour while awake, 20 minutes at a time, for the first 24 hours, then 3 to 4 times a day.⁵ ACFAS suggests 20 minutes, then waiting at least 40 minutes before icing again, with a thin towel between the ice and your skin.¹
• Compress it. An elastic wrap can help control swelling.¹
• Elevate it. Raise your foot on a pillow at or above the level of your heart.⁵
• Start moving when it's time. StatPearls says early functional rehab "is preferred over prolonged immobilization."⁶ MedlinePlus notes pain and swelling most often improve within 48 hours, and you can then begin putting weight back on the foot.⁵

Over-the-counter pain relievers such as ibuprofen or naproxen may ease pain and swelling. Talk with your provider first if you have heart disease, high blood pressure, kidney or liver disease, or a history of stomach ulcers or internal bleeding.⁵

When Does a Sprain Need to Be Checked?

Not being able to walk on the ankle is the biggest red flag. Cleveland Clinic says to see someone right away if you can't walk or put any weight on your ankle.⁴ Doctors use a set of guidelines called the Ottawa Ankle Rules to decide when an X-ray is needed. One sign is being unable to take four steps both right after the injury and at the exam.⁶ StatPearls also notes that a deformed or badly unstable ankle, or signs of nerve or blood-flow problems, should raise concern for a fracture or dislocation rather than a simple sprain.⁶

MedlinePlus advises calling your provider if:⁵

• You can't walk, or walking causes severe pain
• Pain doesn't get better with ice, rest and pain medicine
• Your ankle isn't improving after 5 to 7 days
• The ankle keeps feeling weak or gives way
• Bruising gets worse, or you notice numbness or tingling

ACFAS lists several reasons prompt care matters: a fracture may have happened along with the sprain, other foot injuries can be overlooked, rehab can start right away, and it may help prevent chronic ankle instability.¹ A podiatrist can examine the ankle and may order X-rays or other imaging to judge how serious the injury is.^1,5

Why Do Repeated Sprains Matter?

Most people recover fully, but StatPearls reports that "up to 40% of patients experience residual symptoms."⁶ For some, this becomes chronic ankle instability, a condition marked by the outer side of the ankle repeatedly giving way.²

According to ACFAS, chronic instability usually develops after a sprain that didn't heal well or wasn't fully rehabilitated. A sprain affects your ankle's balance. Without strengthening and retraining, more sprains can follow, and each one can weaken the ligaments further.² Signs include the ankle turning often (especially on uneven ground), ongoing discomfort and swelling, and a wobbly, unstable feeling.² AAOS notes that repeated sprains can also damage the cartilage and bone in the joint, and that an under-treated sprain may lead to "chronic ankle pain, arthritis, and instability."³

Treatment for chronic instability often starts without surgery: physical therapy to build strength and balance, ankle bracing, and anti-inflammatory medicine. Surgery to repair or rebuild the ligaments may be considered if those steps don't help or the instability is severe.²

Can I Lower My Chances of Spraining It Again?

Rehab is a big part of the answer. AAOS describes recovery in stages, moving from rest and ice to range-of-motion work, strengthening and balance training, and then a gradual return to activities that involve quick turns.³ Poor balance and position sense in the ankle raises the risk of another sprain.³ Keep that in mind before heading back onto rocky trails, or icy Montana sidewalks this winter.

The Bottom Line

Most ankle sprains are ligament injuries that improve with protection, ice, compression, elevation and a gradual return to movement. But you can't tell how badly a ligament is hurt, or whether a bone is broken, just by looking. Get checked right away if you can't bear weight, the ankle looks deformed, or your foot is numb. An ankle that keeps rolling is worth a visit too.

If you've sprained your ankle and it isn't getting better, or you keep spraining the same one, our podiatrists can take a look. Learn more about ankle pain care, or request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

1. Ankle Sprain. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
2. Chronic Ankle Instability. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
3. Sprained Ankle. OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS). www.orthoinfo.org
4. Sprained Ankle: Symptoms, Treatment & Recovery Time. Cleveland Clinic. my.clevelandclinic.org
5. Ankle Sprain – Aftercare. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
6. Bergman R, Li D, Shuman VL. Acute Ankle Sprain. StatPearls, NCBI Bookshelf. www.ncbi.nlm.nih.gov