Ankle sprain - aftercare

There are 3 grades of ankle sprains:

• Grade I sprains: Your ligaments are stretched, and there may be slight or microscopic tearing of the ligament tissues. It is a mild injury that can improve with some light stretching.
• Grade II sprains: Your ligaments are partially torn. You may need to wear a splint or other immobilization device.
• Grade III sprains: Your ligaments are fully torn. You will likely need to wear a brace, splint, or cast for several weeks, and you may need surgery for this severe injury, especially for younger or more active persons.

The last 2 kinds of sprains are often associated with tearing of small blood vessels. This allows blood to leak into tissues and cause black and blue color (as with bruising) in the area. The blood may not appear for several days. Most of the time, it is absorbed from the tissues within 2 weeks.

If your sprain is more severe:

• You may feel strong pain and have a lot of swelling.
• You may not be able to walk, or walking may be painful.

Some ankle sprains may become chronic (long-lasting). If this happens to you, your ankle may continue to be:

• Painful and swollen
• Weak or giving way easily

Your health care provider may order an x-ray to look for a bone fracture, or an MRI scan to look for an injury to the ligament.

To help your ankle heal, your provider may treat you with a brace, a cast, or a splint, and may give you crutches to walk on. You may be asked to place only part or none of your weight on the bad ankle. You will also need to do physical therapy or exercises to help you recover from the injury.

You can decrease swelling by:

• Resting and not putting weight on your foot
• Elevating your foot on a pillow at or above the level of your heart

Apply ice every hour while you are awake, 20 minutes at a time and covered by a towel or bag, for the first 24 hours after the injury. After the first 24 hours, apply ice 20 minutes 3 to 4 times per day. Do not apply ice directly to your skin. You should wait at least 30 minutes in between ice applications.

Pain medicines, such as ibuprofen or naproxen, may help to ease pain and swelling. You can buy these medicines without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or more than your provider advises you to take. Carefully read the warnings on the label before taking any medicine.

After your injury you may take acetaminophen (Tylenol and others) if your provider tells you it is safe to do so. People with liver disease should not take this medicine.

The pain and swelling of an ankle sprain most often gets better within 48 hours. After that, you can begin to put weight back on your injured foot.

• Put only as much weight on your foot as is comfortable at first. Slowly work your way up to your full weight.
• If your ankle begins to hurt, stop and rest.

Your provider will give you exercises to strengthen your foot and ankle. Doing these exercises can help prevent future sprains and chronic ankle pain.

For less severe sprains, you may be able to go back to your normal activities after a few days. For more severe sprains, it may take several weeks.

Talk to your provider before returning to more intense sports or work activities.

You should contact your provider if you notice any of the following:

• You cannot walk, or walking is very painful.
• The pain does not get better after ice, rest, and pain medicine.
• Your ankle does not feel any better after 5 to 7 days.
• Your ankle continues to feel weak or gives away easily.
• Your ankle is increasingly discolored (red or black and blue), or it becomes numb or tingly, feels cold, or has changes in sensation.

Lateral ankle sprain - aftercare; Medial ankle sprain - aftercare; Medial ankle injury - aftercare; Ankle syndesmosis sprain - aftercare; Syndesmosis injury - aftercare; ATFL injury - aftercare; CFL injury - aftercare

Farr BK, Nguyen D, Stephenson K, Rogers T, Stevens FR, Jasko JJ. Ankle sprains. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 39.

Krabak BJ, Butler AW. Ankle sprain. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 83.

Rothenberg P, Swanton E, Molloy A, Aiyer AA, Kaplan JR. Ligamentous injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 117.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.