Ankle Sprain: Signs, Home Care and When to Be Seen

What it involves

MedlinePlus says an ankle sprain occurs when the ligaments in your ankle are stretched or torn. Ligaments are strong, flexible tissues that attach your bones to one another, keep your joints stable, and help them move in the right ways. In most cases the ankle is twisted inward, which causes small tears in the ligaments, swelling and bruising, and makes it difficult to put weight on the joint. The ligaments on the outside of the ankle are injured more often than those on the inside.

Who this is for

• Adults who twisted or rolled an ankle and still have pain or swelling after a day or two
• Patients who can walk but feel the ankle is weak, unsteady, or giving way
• Patients who have sprained the same ankle more than once
• Patients unsure whether an injury needs an exam, an x-ray referral, or just rest at home

What to expect

• Questions about how the ankle twisted, when it happened, and whether you could walk right afterward
• A physical exam of the ankle, foot, and lower leg, checking swelling, bruising, and how the joint moves
• A plain explanation of how bad the sprain looks and what to do at home while it heals
• A plan that may include a brace or support, a referral for an x-ray or other imaging, and follow-up

The three grades of ankle sprain

MedlinePlus describes three grades. In a grade I sprain the ligaments are stretched, with slight tearing, and it can improve with light stretching. In a grade II sprain they are partially torn, and you may need a splint. In a grade III sprain they are fully torn, and MedlinePlus says you will likely need a brace, splint, or cast for several weeks and may need surgery. Black and blue color can show up days after the injury and is usually absorbed within 2 weeks.

Other causes of ankle pain

MedlinePlus says ankle pain is often due to a sprain but can also come from damaged or swollen tendons or cartilage, infection in the ankle joint, or arthritis. If the ankle hurts with no injury, or the swelling has no clear cause, the leg swelling evaluation and the gout evaluation describe two other things a provider checks.

What to do at home first

MedlinePlus suggests resting the ankle and not putting weight on it, keeping the foot raised at or above the level of your heart, and applying ice covered by a towel for 20 minutes at a time, every hour while awake for the first 24 hours, then 3 to 4 times a day. Never put ice directly on the skin. Ibuprofen or naproxen may ease pain and swelling, but MedlinePlus says to talk with your provider first if you have heart disease, high blood pressure, kidney disease, liver disease, or a history of stomach ulcers or internal bleeding.

Getting moving again

MedlinePlus says the pain and swelling most often get better within 48 hours, and after that you can start putting weight back on the foot. Use only as much weight as is comfortable at first, and if the ankle starts to hurt, stop and rest. Your provider can give you strengthening exercises, which MedlinePlus says help prevent future sprains. Talk to your provider before returning to hard sports or heavy work.

When to go to the hospital or call 911

MedlinePlus says to go to the hospital, or call 911 or the local emergency number, if:

• You think you have a broken bone, or the joint looks out of position
• You cannot put any weight on the leg, or cannot move the ankle back and forth
• You heard a pop and had immediate pain in the joint
• You have severe pain without bearing weight, or a lot of swelling in the foot and ankle

When to book a visit

MedlinePlus says to contact your provider if the swelling does not go down within 2 to 3 days, if the ankle does not feel any better after 5 to 7 days, or if it stays weak or gives way. It also lists increasing discoloration, numbness or tingling, a cold foot, and signs of infection such as red, warm skin or a fever over 100 degrees Fahrenheit. The adult fever guide covers fevers, and the sick visit, urgent care, or ER guide explains which setting fits.

What a visit involves

MedlinePlus says your provider may order an x-ray to look for a broken bone or an MRI to look for a ligament injury, and may treat the sprain with a brace, cast, or splint, sometimes with crutches. It also says you will need exercises or physical therapy to recover. The practice's role is the exam, the plan, and follow-up, with imaging and therapy arranged through a referral. The knee pain guide and the heel pain guide cover neighboring joints.

Sources

• MedlinePlus — Ankle sprain - aftercare
• MedlinePlus — Ankle pain
• MedlinePlus — Sprains