Sprained Ankle

Overview

What is a sprained ankle?

A sprained ankle is a common injury when the tissue that connects your ankle bones and supports your ankle (ligaments) is torn or stretched beyond its limits, often after a fall, ankle roll or twist.

What is the difference between a sprained ankle and a broken ankle (ankle fracture)?

A sprained ankle is when the ligaments in your ankle are torn. A broken ankle or ankle fracture is when one or more of the bones in your ankle break. Severe sprains and fractures have similar symptoms (pain, swelling, bruising, tenderness) and are both caused by twisting or rotating your ankle, tripping or falling, or trauma to your ankle. Sprains heal faster, but it can take up to six weeks for a broken ankle to heal.

Who does it affect?

Anyone, at any age, can sprain their ankle. Sprains are most common in athletes during sporting events, but can happen during everyday activities as well.

What are the types of ankle sprains?

There are three types of ankle sprains based on how much ligament damage occurred:

  • Grade 1 (Mild). The ligament fibers stretched slightly or there is a very small tear. Your ankle will have minor swelling and tenderness to the touch.
  • Grade 2 (Moderate). The ligament is torn, but it isn’t a complete tear. Your ankle has swelling over the injury and it hurts to move.
  • Grade 3 (Severe). The ligament is torn completely. Your ankle has significant swelling, the injury is painful and walking is difficult.

Symptoms and Causes

What are the symptoms of a sprained ankle?

The symptoms of a sprained ankle include:

  • Pain, especially when putting weight on your ankle.
  • Tenderness to the touch.
  • Swelling.
  • Bruising.
  • Difficulty walking.

What causes a sprained ankle?

Rolling or twisting the ankle causes ankle sprains. The most common ankle sprains are the result of:

  • Falling or tripping on uneven surfaces.
  • Landing incorrectly after a jump.
  • Losing balance.
  • Participating in sports that involve rolling or twisting your foot (basketball, football, soccer, tennis).

Diagnosis and Tests

How is a sprained ankle diagnosed?

Your healthcare provider will diagnose your sprained ankle after a physical examination of your foot and ankle to identify your range of motion and determine which ligaments are affected. The physical exam is typically followed by an imaging test, like an X-ray.

How do I know if I sprained my ankle?

If you fell or twisted your ankle, and the injury causes you pain, swelling, bruising and you have trouble walking, you can assume that you have a sprained ankle. Visit your healthcare provider and they'll assess the injury, confirm the diagnosis and offer a treatment plan.

Management and Treatment

How is a sprained ankle treated?

For the majority of ankle sprains, healthcare providers recommend using the PRICE method for the first 24-48 hours after injury. PRICE stands for protection, rest, ice, compression and elevation.

  • Protection. Use crutches or apply a splint or brace to limit use of your injured ankle.
  • Rest. Limit physical activities that may cause stress to the sprain (no running, jumping, exercising).
  • Ice. Apply ice or a cold pack in a towel to your ankle in 20-minute increments to reduce swelling.
  • Compression. Gently wrap your ankle in an elastic bandage to help decrease swelling.
  • Elevation. Raise your ankle on pillows while you’re sitting or lying down so that it's higher than your heart.

If your sprain is very painful and swollen or you're having trouble walking and putting pressure on your ankle, visit your healthcare provider for treatment.

What medications are used for a sprained ankle?

Anti-inflammatory drugs, like ibuprofen, may help alleviate pain and swelling from the sprain.

How long will my sprained ankle be swollen?

Swelling normally doesn't appear immediately. It could take several hours to develop. If you develop swelling, it could last up to 48 hours for a mild to moderate sprain. Swelling on severe sprains may last longer until your torn ligament heals.

Can I walk on a sprained ankle?

Your healthcare provider may recommend the use of crutches, a boot or a brace/splint to keep weight off of your ankle and give your ankle support and stability (protection). Putting too much pressure on a sprained ankle could worsen the sprain, cause more discomfort and prolong healing time.

Do I need physical therapy after an ankle sprain?

Your healthcare provider may recommend physical therapy to help you regain strength and mobility. Physical therapy is common for athletes, so you can return to your sport once the injury heals. There’s evidence to support physical therapy as important to proper healing.

Do I need surgery to treat my sprained ankle?

Surgery is rare to treat an acute ankle sprain. If you have long-term problems with your ankle like instability — rolling your ankle repeatedly — then your healthcare provider may recommend surgery.

Do ankle sprains heal on their own?

Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. If you don't allow your ankle ligaments time to heal, you may have long-lasting instability (chronic ankle sprains) or repeat ankle sprains. If your symptoms continue for more than four to six weeks after injury and you still feel weakness when walking on your foot, you may have a chronic ankle sprain.

Prevention

How can I reduce my risk of getting a sprained ankle?

In order to prevent ankle sprains, you can:

  • Maintain good muscle strength by exercising regularly.
  • Warm up and stretch before exercise and physical activity.
  • Pay attention to uneven surfaces where you’re walking or running.
  • Slow down or stop if you feel tired during activities or exercise.

Outlook / Prognosis

What can I expect if I have a sprained ankle?

After giving your ankle time to heal and treating the sprain according to your healthcare provider’s recommendations, you'll be able to get back to regular activities. Your prognosis depends on your commitment to building strength back in your ankle through exercises and rehabilitation. If your ankle hasn't healed completely or you stopped the strengthening exercises, your injured ligament could weaken and put you at risk for future ankle sprains.

How long does a sprained ankle take to heal?

The recovery time for a sprained ankle varies depending on the severity of your injury. It may take anywhere from two weeks to heal a minor sprain and anywhere from six to 12 weeks to heal a severe sprain.

Living With

How do I take care of myself?

After treating your sprain with the PRICE method, you'll need to build back flexibility and strength in your ankle. Perform exercises recommended by your healthcare provider or physical therapist to improve your range of motion.

Physical therapy exercises include:

  • Motion-controlled movements without resistance.
  • Strength training for the muscles and tendons in the front and back of your legs.
  • Balance training (proprioception) to prevent future sprains.
  • Endurance and agility exercises for calf and ankle strength.

Early exercises in your treatment plan will not require you to turn or twist your ankle, but over time, you'll be able to get back to regular activities that may require sudden turns (like playing football or basketball).

When should I see my healthcare provider?

You should visit your healthcare provider for severe sprain evaluation if you can't walk after an injury and your swelling and pain haven't improved or have gotten worse 24-48 hours after the sprain occurred.

What questions should I ask my doctor?

  • How severe is my sprain?
  • Is this a sprain or is my ankle broken?
  • Do you recommend I use crutches?
  • Should I visit a physical therapist to improve strength in my ankle?

Frequently Asked Questions

What's a high ankle sprain and how does it differ from an ankle sprain?

The difference between a high ankle sprain and an ankle sprain depends on the location and ligaments that were injured. Ankle sprains are grouped into two location-based categories:

  • Inversion. An inversion sprain is the most common and occurs when the ankle turns in or out and the ligament on the outside of your ankle tears. Trips and falls cause inversion sprains.
  • External rotation. An external rotation injury tears the ligament between the fibula and tibia, known as the syndesmosis ligament. This is also called a high ankle sprain, and is a common sports injury.

A note from Cleveland Clinic

The first 24-48 hours after an ankle sprain are the most uncomfortable, but symptoms can be relieved with at-home treatment, including icing and elevating the injury to reduce swelling. Rebuilding strength in your ankle after a sprain can help prevent future sprains. Always pay attention to the surfaces you're walking or exercising on to avoid accidental trips and falls that could lead to sprains.

Last reviewed by a Cleveland Clinic medical professional on 10/26/2021.

References

  • American Academy of Orthopaedic Surgeons. Sprained Ankle. (https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/) Accessed 10/26/2021.
  • American Academy of Orthopaedic Surgeons. Ankle Fractures (Broken Ankle). (https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/) Accessed 10/26/2021.
  • Merck Manual. Overview of Sprains and Other Soft-Tissue Injuries. (https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries#v13386203) Accessed 10/26/2021.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Sprains and Strains. (https://www.niams.nih.gov/health-topics/sprains-and-strains#tab-overview) Accessed 10/26/2021.
  • Papadakis M.A., & McPhee S.J., & Bernstein J. Quick Medical Diagnosis & Treatment. (https://accessmedicine-mhmedical-com.ccmain.ohionet.org/content.aspx?bookid=2986&sectionid=251086882) New York: McGraw Hill; 2021. Accessed 10/15/2021.

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