May 5, 2018

How to Care for a Sprained Ankle

By Dr. Aaron O’Brien


Ankle sprains are very common injuries. There is a good chance that you have experienced the feeling of your ankle rolling inward after stepping awkwardly on an uneven surface. Over 25,000 people do this every day. This is one of the more common injuries I treat as a foot and ankle orthopedic surgeon.


Most of the time ankle sprains are only minor injuries and the pain quickly fades. Other times the sprain is more severe. The ankle may swell, there may be intense pain, a “pop” may have been felt and it might hurt too much to stand or walk on.

What is a sprained ankle?

Most ankle sprains occur when the foot twists inward (inversion sprain) causing excessive stretch to be placed on the outside ankle ligaments. Based on the severity, they can be classified into 3 grades. Grade 1 is a stretch injury and recovers relatively quickly. Grade 2 involves a partial tear of one or more of the ligaments. Grade 3 is a complete tear.


How do you know if it is a sprain or a break?

It may be difficult to differentiate between the two. A severe ankle sprain can often feel as painful as a fracture (broken bone) and the only way to be certain is to obtain an x-ray. If you are unable to bear weight and there is severe swelling or deformity you should seek medical treatment from a doctor (MD or DO). This may be your primary physician or pediatrician, the emergency department or an orthopedic surgeon depending on the severity of the injury.


How do you treat an ankle sprain?

Treating your ankle sprain properly may prevent chronic pain and instability. For Grade 1 sprains follow the R.I.C.E. guidelines:

  • Rest your ankle. Avoid walking on it if it hurts. Using crutches and putting only partial weight on it may be necessary. If there is no fracture then it is safe to put some weight on the foot but an ankle brace may help with stability and swelling.
  • Ice it to help keep the swelling down. Avoid ice directly on the skin (use a thin piece of cloth between the skin and ice) and don’t ice longer than 20 minutes to avoid frostbite.
  • Compression will help control swelling, provide support and immobilize your ankle.
  • Elevate the foot above the level of the heart to help reduce swelling


Grade 1 sprains usually feel better within a week.

Grade 2 sprains should also be treated with R.I.C.E. but will take longer to heal. A doctor may immobilize your ankle in a splint or boot to add comfort and help with the healing.

A Grade 3 sprain puts your ankle at risk of permanent instability. Rarely surgery may be performed to repair the ligaments, especially in a competitive athlete. Surgery is most often reserved for those who repeatedly sprain their ankles.


Grade 2 and 3 injuries should also be treated with appropriate rehabilitation to regain flexibility, strength, balance and coordination which can be prescribed by your doctor. This rehabilitation program can either be done on your own or with a therapist who will guide you through the processes and help you achieve a full recovery. It is important to finish the rehabilitation program because it makes it less likely to sprain the same ankle again.


Chronic pain, instability, and ankle arthritis can occur if the proper treatment is not obtained. If your ankle still hurts after rehabilitation it is possible that your ligament has not healed correctly or there is some other injury present. You should see your orthopedic surgeon if this occurs. To prevent future ankle sprains it is important to listen to your body’s warning signs to slow down when you feel pain or fatigue. Stay in shape with good muscle balance, strength, flexibility.

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