How to diagnose an ankle sprain and carry out first aid treatment following the PRICE principle.
Medically reviewed by Dr Juliet McGrattan (MBChB) and Based on a text by Dr Hans Gad Johansen and Dr Ejnar Kuur
Suspect you might be suffering from an ankle sprain? To help you get back on your feet we look at ankle sprain diagnosis, danger signs and home treatment tips:
How do you sprain an ankle?
A sprained ankle happens when the ligaments that hold the ankle joint together have been damaged by over-stretching or twisting. Ligaments are strong tissues that run from bone to bone and keep joints stable.
When you twist your ankle, your foot usually twists inwards (going over on your ankle), damaging the ligaments on the outside of the ankle. Twists damaging the inside ligaments are rarer.
The majority of cases of ankle sprain are sports injuries, but a sprained ankle can also happen in everyday life.
If you do not allow the injury time to recover and follow the appropriate physiotherapy advice or treatment, then you will be more likely to sprain the area again.
What does a sprained ankle feel like?
A sprained ankle can be painful, but the speed of onset and the severity of the pain can vary greatly. Sometimes, the pain can be delayed – and at other times it’s instant. The level of pain isn’t always a measurement of the extent of the damage. Some people hear a ‘pop’ in their ankle. This could suggest a torn ligament. The twist is followed by swelling of the area.
A sprained ankle can be painful, but the speed of onset and the severity of the pain can vary greatly.
Rapid, significant swelling usually indicates severe damage has taken place.
The swelling is caused by inflammation and bleeding of the damaged tissue which may result in a bruise or discolouration. Gravity pulls blood and tissue fluids downwards so, the swelling is often situated a small distance away from the actual damaged site.
Sprained ankle danger signs
After a sprain you may feel that your ankle is unstable, you may have problems controlling it, or you may have balance problems when standing on the affected foot. In these circumstances, it is essential to get advice about appropriate physiotherapy treatment and exercise.
If you have persistent pain and a feeling of instability, you may have sustained damage other than a sprain. These symptoms need further assessment by a doctor.
Sprained ankle home treatment tips
Injuries of this kind should receive first aid treatment following the PRICE principle. This stands for: Protection, Rest, Ice, Compression and Elevation.
Cooling the injury as fast as possible will reduce the swelling and pain.
Protect the ankle joint from the risk of further injury by wearing shoes that support and enclose your feet.
The injured foot must be rested for the first 48 to 72 hours to prevent any further injury. Avoid massage and heat treatment during this period.
The damaged area must be cooled by using an icepack or a packet of frozen peas. The ice must never have direct contact with the skin or you could get an ice burn. A cloth should be placed between the ice and the skin. Ice can be laid on the affected area for up to 20 minutes every to to three hours. Ice treatment has been known to be effective for up to 24 hours after the injury occurred.
The compression must be firm but not too tight. It must not be allowed to affect the blood circulation. If you are known to have peripheral arterial disease (PAD) that compromises the blood flow to your feet, it is best to seek advice from your GP on whether or not it is safe to apply compression to your ankle for any period of time. An elasticated bandage from the toes to the middle of the lower leg would be ideal.
The foot must be elevated above heart level. It is most comfortable to lie down and elevate the limb with a few pillows.
If you are sitting down, the legs can be raised on a chair or a table. This elevation should be maintained for a few days.
Sprained ankle diagnosis
The doctor will assess the degree of swelling and the extent of the damage and whether the tenderness corresponds to the position of the ligaments or bones.
Finally, any weakness of the ankle will be assessed. If a fracture is suspected, an X-ray examination will be necessary.
Sprained ankle future prospects
Depending on how bad the damage is, sprained ankle symptoms will usually go away between one and four weeks after the accident.
It is most important NOT to DRIVE if your ankle is weakened and painful. Please be advised by your physiotherapist or GP as to when it is going to be advisable in your individual case to return to the road and safe driving.
Depending on how bad the damage is, sprained ankle symptoms will usually go away between 1-4 weeks.
The immediate tenderness can persist for one to four weeks, depending on the extent of the damage. Support-related pain can persist for up to three months.
With the correct approach, there will rarely be any lasting symptoms but a small number of people have ongoing pain and a feeling that their ankle is weak. If this is the case, further investigation may be needed to find the cause of any ongoing symptoms.
For a more severe sprain, you need physiotherapy and you should not do any sports training for at least six weeks.
Sprained ankle treatment
The primary treatment by PRICE is adequate to achieve recovery following minor sprains. Avoid damaging the ankle further by not allowing it to bear too much weight too early.
Physiotherapy is aimed at starting to move the foot after one or two days with gentle rotation and forward and backward movements of the foot. Simple ankle stretches will help too. After this, once able to weight bear, balance training is required. This can be as simple as standing on one leg initially and then progressing to bending and straightening the knee while doing so. Physiotherapists may use other apparatus such as a wobble board or seesaw board or a trampoline. This is important to restore the stability of the ligaments.
Later in the recovery period more complicated running patterns can be attempted to increase strength– such as running zigzags, figures of eight and so on.
If the ankle is not allowed to mend properly, people often complain of loose joints or ligaments and claim they have a ‘weak ankle’. This is almost always avoidable by patience and rehabilitation. It is better for you to be able to concentrate 100 per cent on enjoying exercise than worrying about the risk of another injury due to lack of careful rehabilitation training.
Sprained ankle medication
The pharmacist will usually recommend paracetamol initially and 48 hours after the injury, a non-steroidal anti-inflammatory drug, such as ibuprofen can be used.
Your pharmacist will check that ibuprofen is suitable for you and also be able to advise you about creams, gels and support bandages which can be used to treat minor sprains and be bought without a prescription.