Sprained Ankle

Medically Reviewed by Melinda Ratini, MS, DO on February 25, 2022
5 min read

Your ankle joint connects your foot with your lower leg. Three ligaments keep your ankle bones from shifting out of place. A sprained ankle is when one of these ligaments is stretched too far or torn.

Doctors grade ankle sprains by how severe they are:

  • Mild (grade I). Your ligaments are stretched but not torn. Your ankle still feels stable. You may have some pain and stiffness.
  • Moderate (grade II). One or more ligaments are partially torn. The joint isn’t totally stable, and you can’t move it as much as usual. You have swelling and moderate pain.
  • Severe (grade III). One or more ligaments are totally torn, and your ankle is unstable. You have a lot of pain and can’t move it.

Anything that stretches your ankle more than it’s used to can hurt a ligament. This usually happens when your foot is turned inward or twisted, such as when you:

  • Plant your foot the wrong way when running, stepping up or down, or doing everyday things like getting out of bed
  • Step on an uneven surface, like in a hole
  • Step on someone else while playing sports. (For example, your foot might roll when you’re playing basketball, go up for a rebound, and come down on top of another player’s foot.)

Certain people are more likely to sprain their ankles. Women, children, and teenagers tend to have more sprains. You might also be at higher risk if you:

  • Play sports, especially on an indoor court
  • Have balance problems
  • Wear high heels or shoes that don’t fit well
  • Have weak or stiff ankles, such as because of a previous injury

The inflammation that comes along with a sprained ankle can cause symptoms including:

  • Swelling and bruising. It may be so swollen that you can press on the area with your finger and leave an indent.
  • Pain. Your nerves are more sensitive after a sprain. The joint hurts and may throb. It’s often worse when you press on it, move your foot in certain ways, walk, or stand.
  • Redness and warmth. A sprain causes more blood to flow to the area.
  • Instability. The joint can feel weak when the ligament is totally torn.
  • Trouble walking. A sprain may limit how much you can move your ankle.

When to call your doctor

You probably won’t need to see your doctor about a sprain. But give them a call if:

  • Your pain is severe or doesn’t get better with over-the-counter medications, elevation, and ice
  • You can’t walk, or you have severe pain when you do
  • Your ankle doesn’t feel better within 5 to 7 days

You might have a bone fracture instead of a sprain if:

  • You have severe pain or pain that doesn’t get better with treatment
  • Your foot or ankle is twisted or extremely swollen
  • You can’t walk without pain
  • You have severe pain when you press your medial malleolus or lateral malleolus, the bony bumps on each side of your ankle

Other problems can develop over time if you don’t treat a sprained ankle, try to do too much before it’s completely healed, or sprain it more than once. These complications include:

  • An unstable joint
  • Pain
  • Arthritis
  • Injuring the other ankle because of changes in how you walk

Your doctor will try to rule out a bone fracture or other serious injury. They’ll move your foot and ankle to learn what bones are affected and make sure your nerves and arteries aren’t hurt. They’ll also check that your Achilles tendon, which runs along the back of your ankle, isn’t torn.

You might have X-rays to check for fractures. If your sprain is severe, your doctor may order more imaging tests, including:

  • MRI. This can make pictures of things inside your body to show torn ligaments, damaged cartilage, bone chips, and other problems.
  • Ultrasound. This shows your doctor what your ligament looks like while you move your ankle.
  • CT scan. This uses X-rays and a computer to make detailed pictures of your bones.

Home treatment

Doctors recommend RICE:

  • Rest keeps you from hurting the ankle again or putting stress on inflamed tissue. A brace or splint can take pressure off the joint.
  • Ice is probably the best treatment. Put it on your ankle to lower blood flow and help with swelling, redness, and warmth. It can prevent inflammation if you do it quickly after an injury.
  • Compression can keep down swelling. Use an elastic bandage or wrap until the swelling goes down. Always start wrapping at the point farthest from your heart. Don’t wrap so tightly that you cut off the blood flow.
  • Elevation (keeping the injured area up as high as possible) will help your body absorb extra fluid. It’s best to prop your ankle up so that it’s higher than your heart, as with a reclining chair.

Anti-inflammatory pain medications reduce pain and fight swelling. Over-the-counter drugs such as ibuprofen and naproxen work for most people. Check with your doctor first if you have other health conditions or take any other medicines.

Medical treatment

If your sprain is severe or isn’t feeling better after about a week, you may need to see a doctor. They might give you a brace or cast to hold your ankle still. You can use crutches to keep weight off it. If you have a severe sprain, have a follow-up appointment 1 or 2 weeks later to make sure you’re healing well and learn whether you might need physical therapy to help with flexibility and strength.

Mild and moderate sprains usually don’t need surgery. You might have it if the sprain is severe or if you’re at higher risk of spraining it again because you play a lot of sports.

A sprained ankle is more likely to get hurt again, so do what you can to lower your risk:

  • Keep your ankles strong and flexible. Talk to your doctor or physical therapist about strengthening exercises.
  • Wear the right shoes for an activity. Choose stable shoes that support your ankle, such as high-top basketball shoes.
  • If you play a sport, you might want to tape up a weak ankle for extra support. Ask your doctor about a brace if you’ve had more than one sprain.
  • Be sure the playing field or court is clear of any holes or obstacles.
  • Get rid of obstacles or trip hazards in your home and yard.

Most ankle sprains heal with no problems. You should feel much better after 2 weeks. Up to a third of people still have some pain after a year.

Once the swelling has gone down and you can walk without pain, you can probably start exercises to build flexibility and strength. Check with your doctor first.

Media file 1: Ankle sprain. Medial and lateral malleoli, the "bumps" on either side of the ankle. The medial malleolus is formed by the tibia, while the fibula forms the lateral malleolus.

Media file 2: Ankle sprain. Inversion injury of ankle. Note it is turned inward.