Condition guide
The ankle usually rolls inwards, straining or tearing the ligaments on the outer side. Most sprains heal without surgery. Early, gradual weight-bearing, exercise and balance training support recovery and also stop the same ankle from being sprained again.
When the ankle turns inwards suddenly and forcefully, the ligaments in front of and below the outer ankle bone are stretched or torn. This causes pain, swelling and bruising, and it becomes hard to put weight on the foot.
If rehabilitation is left unfinished after a sprain, the ankle can become prone to spraining again, and some people develop a frequent feeling of the ankle giving way (chronic instability).
Most sprains do not involve a fracture and do not need an X-ray. The Ottawa ankle rules were developed to identify which patients need an X-ray, and in a review that combined 27 studies, they caught 97.6% of fractures.
You need an X-ray if there is pain around the ankle together with any of the following: bone tenderness along the back edge of the lower 6 cm, or at the tip, of the inner or outer ankle bone; or being unable to take 4 steps both straight after the injury and at the examination.
The American Physical Therapy Association's 2021 guideline groups treatment after a sprain under the following headings.
Exercises at home
You can start the first two exercises early on. As pain and swelling ease, move on to the strengthening and balance exercises. For exercises done standing, hold on to something sturdy; stop if you feel sharp pain.
Sit or lie down with your leg straight. Pull your toes up towards you, then push them down; then draw circles with your ankle in both directions. From the first days, this helps reduce swelling and keep the ankle moving.
10 reps in each direction, 3–4 times a daySit with your legs straight, loop a towel around the front of your foot and hold the ends. Keeping your knee straight, pull the towel towards you; feel a stretch in your calf. Stay within a pain-free range.
30 seconds, 3 repsSit down, loop a resistance band around the front of your foot and fix the other end on the opposite side. Keeping your heel on the floor, turn your foot outwards, then slowly bring it back. This strengthens the muscles on the outer side of the ankle.
10–15 reps, 2–3 setsHolding on to the counter, rise up onto your toes on both feet, then lower slowly. As it gets easier, do it on your sprained foot only.
10–15 reps, 2–3 setsStand close to the counter and balance on your sprained foot. As it gets easier, let go of the support, close your eyes or try it on a soft surface such as a cushion. This is the key exercise for preventing further sprains.
30 seconds, 3–5 repsAlong the counter or a wall, walk in a straight line, placing the heel of your front foot just in front of the toes of your back foot.
10–15 steps, 2–3 roundsThe pain going away does not mean your ankle has fully recovered. Returning gradually prevents further sprains.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
Movement and strengthening work after a sprain.
Strengthening exercises to do once range of motion has returned.
Yes, as far as the pain allows. The American Physical Therapy Association's guideline recommends protecting a new sprain with support such as tape or a brace, and gradually putting weight on the foot. Keeping all weight off it for a long time can slow recovery.
For most sprains, no. According to the Ottawa rules, you need an X-ray if you cannot take 4 steps both straight after the injury and at the examination, or if there is bone tenderness along the back edge of the lower 6 cm of the inner or outer ankle bone. These rules catch almost all fractures.
Used alongside an exercise programme, repeated ice applied on and off is one of the methods the guideline lists for reducing pain and swelling. Do not put ice directly on your skin; place a thin cloth in between.
Using support after a new sprain is recommended. For people who have had a sprain, wearing a brace during sport and doing balance exercises are also recommended to prevent further sprains.
If your balance, muscle strength and sense of where your ankle is have not fully recovered after a sprain, the ankle becomes prone to spraining again. The way to break this cycle is to keep doing balance and strengthening exercises even after the pain has gone, and to return to sport gradually.
See a doctor without delay if you have any of the following:
Sources
İhsan Eren