Ankle Sprain
A stretch or tear of the ligaments, usually on the outside of the ankle after rolling it. Most people can walk on it within days and recover in 2 to 6 weeks, though severe sprains take longer. Without rehabilitation, up to 1 in 3 people go on to have repeat sprains or a weak, unstable ankle.
Do I need an X-ray? Most sprains don’t. Doctors use the Ottawa ankle rules: you need one if you couldn’t take 4 steps straight after the injury and still can’t, or if there is bone tenderness at the back edge or tip of either ankle bone, at the base of the outer long bone of the foot, or over the bony bump on the inner midfoot.
Treatment options
Ratings show how strong the research is.
- Strong evidenceExercise and balance trainingStart gentle movement (such as tracing the alphabet with your foot) in the first days, then add calf raises and single-leg balance. Reduces repeat sprains. A physio can guide you.
- Moderate evidenceEarly walkingWalk as soon as pain allows, using crutches briefly if needed. Faster recovery than rest.
- Moderate evidenceBrace or tapeA lace-up brace or tape is better than a bandage alone. Wear it for sport for at least 6 months.
- Moderate evidenceAnti-inflammatoriesGel or tablets for a few days ease pain and swelling. Tablets aren’t suitable for everyone, so check with your pharmacist.
- Moderate evidenceShort-term boot or castFor a severe sprain, a doctor may suggest one for up to 10 days, then rehab.
- Limited evidenceIce, compression and elevationIce (wrapped, 15 to 20 minutes every 2 to 3 hours) and raising the leg may ease pain and swelling in the first 2 days.
- Limited evidenceSurgeryRarely needed. Only for ongoing instability after a full rehab program.
- Not recommendedLong periods in a cast or no movementSlower recovery and more stiffness than early movement.
What you can do
- For the first 2 to 3 days, avoid heat, alcohol, running and massage, which can increase swelling.
- Use pain as a guide: mild discomfort with exercise is fine.
- Return to sport once you can hop and change direction without pain.
- Keep up balance exercises for 3 months, even when it feels better.
See your GP if
- You can’t walk 4 steps, or have bone tenderness (see the X-ray rules above)
- Not improving after 1 week, or still painful or unstable after 6 weeks
- The ankle keeps giving way
- Pain is high on the shin, or at the back of the heel (Achilles)
Go to the emergency department if the ankle or foot looks deformed, is cold, pale or numb, or a bone is visible.
Evidence and more information
maladywise.com/ankle-sprain/