Ankle sprain: treat it properly the first time

What it is, in plain words

An ankle sprain stretches or tears the ligaments on the outside of the ankle when the foot rolls inwards. The ligament fibres are damaged, the joint swells, and the position sensors inside the ligament are disrupted, which is why balance stays impaired long after the pain has gone.

Signs to look out for

• Immediate pain on the outside of the ankle after a twist
• Rapid swelling and bruising over the following hours
• Difficulty and pain on weight bearing
• Tenderness just below and in front of the outer ankle bone
• A recurring feeling of the ankle giving way in the months afterwards

Why it happens

Sprains are the commonest sports injury. Risk is much higher if you have sprained the same ankle before, and higher on uneven ground, in court sports and with fatigue.

How doctors confirm it

The Ottawa ankle rules decide who needs an X-ray: bone tenderness at specific points, or inability to take four steps, suggests a fracture. Otherwise imaging is unnecessary at first.

Treatments and solutions

• Protection, Optimal Loading, Ice, Compression and Elevation in the first days, with early gentle weight bearing rather than strict rest
• A brace or taping for the first weeks, which is more effective than a rigid cast for most sprains
• Range of movement exercises started within a few days, then strengthening of the calf and peroneal muscles
• Balance and proprioception training on one leg, progressing to unstable surfaces, for at least six to eight weeks, which halves the risk of recurrence
• Gradual return to sport with change-of-direction drills before competition

Living with it day to day

The commonest mistake is stopping rehabilitation when the pain disappears at three weeks. Complete the balance programme even when the ankle feels normal.

When to seek medical help

Seek medical assessment for inability to bear weight, an obviously deformed ankle, numbness in the foot, or pain that is not improving after a week.

This article explains general health information in simple language. It does not replace advice from your own doctor.