In the architecture of your body, the ankles are among the most vulnerable elements. These complex hinges of bone, ligament, tendon, and muscle support your entire body weight and may absorb a force of impact equal to three to four times your weight when you run or jump. A sprained ankle is the most common of all joint injuries. It occurs when the bone is forced out of the ankle joint because of a tear of one or more of the multiple fascia and ligaments securing the bone in the joint.
Anyone is susceptible to ankle sprains—from the basketball pro to the average runner navigating an uneven surface to the woman in high heels stepping off a curb.
Ankle sprains are graded as mild (the ligament is strained or stretched), moderate (a partially torn ligament), and severe (a complete tear, meaning that the ligament can no longer control the ankle joint). If you hear a popping sound when your ankle turns, that probably means you have a severe sprain or a possible fracture.
Minor sprains, in which the ankle bone is tipped slightly out of place for an instant, often can be successfully treated at home. Moderate and especially severe sprains, however, need medical attention. Any sprain can put you at risk for another because, when the injury heals, it leaves the tendon weakened, less flexible, and more susceptible to injury.
Symptoms of Ankle Sprain
- Pain, soreness and tenderness, from mild aching to intense pain
- Swelling of the ankle, usually occurring very quickly after the injury
- Inability to move the ankle or to stand and put pressure on it
- Ankle stiffness
What Causes Ankle Sprain?
The great majority (about 85 percent) of sprains are inversion sprains. This happens when the sole of the foot turns inward, injuring the ligaments on the outside of the ankle. Basketball players who land on the edges of their feet and runners who step into potholes are among those who most commonly sustain inversion sprains. Eversion sprains occur when the foot turns outward, affecting ligaments on the inner side.
What If You Do Nothing?
Very minor sprains will improve on their own. However, in cases where there is swelling, discoloration, or intense pain, you should attend to the injury immediately.
Home Remedies for Ankle Sprain
If you can put weight on the ankle and if the swelling and pain are slight, you may not need medical attention right away or at all. Icing the injury as soon as you can is essential; follow up the icing with the other steps of RICE (rest, ice, compression, elevation), as explained below. Maintain the treatment for up to 72 hours, if necessary.
Most sprains, even the most severe, do heal without complications. It takes about 10 days for a mild sprain to heal, though it takes longer for the full range of motion to return.
- Rest. Avoid any activity that causes pain. Keep weight off the ankle. Using crutches, even for mild sprains, is advisable for the first few days.
- Ice. Apply ice to the injury as soon as you can. Ice applied for 10 to 20 minutes about every 2 hours for 24 to 48 hours will reduce pain, inflammation, and any further bleeding into the ankle joint. You may apply ice at more frequent intervals if necessary.
- Compress. Securely wrap the ankle in an elastic bandage and keep the bandage on during your waking hours. Be careful not to apply it so tightly that it causes pain or additional swelling or compromises blood flow to the area.
- Elevate. Whenever you are resting or sleeping, make sure your foot is elevated slightly higher than your heart. This helps draw fluids away from the injury, decreasing swelling.
- Physical therapy as early as possible. This includes doing the prescribed exercises to promote healing and increase range of motion.
- Try over-the-counter pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen will help reduce pain and swelling, though they won’t accelerate healing. Acetaminophen will help with pain but not inflammation.
Can High-Tops Help?
For active sports where there is a tendency to roll over on the ankle, most (but not all) evidence shows that wearing snugly-laced hightop shoes is protective. These aren’t floppy canvas high-tops but the padded, flexible shoes worn by basketball players. Such shoes stabilize the ankle and protect against injuries. According to the American Orthopaedic Foot and Ankle Society, a study of Israeli army recruits showed that high-top basketball shoes were as effective as army boots in protecting against ankle injuries. A study of basketball players at the University of Washington School of Medicine in Seattle also showed that ankle taping combined with high-tops offered good protection.
When shopping for high-top shoes, look for a pair with an ankle collar that is high enough to firmly support your ankles.
Heel raises and dips, for strengthening calf muscles. Standing with the balls of your feet on a thick book or step, slowly rise on your toes, then lower your heels as low as you can. Repeat. Use your hands for balance, not support. Gradually work up to 20 repetitions.
Calf stretch, for stretching muscles of the lower leg. Stand 2 to 3 feet from a wall, with feet perpendicular to wall, and lean against it for 10 to 30 seconds. Keep your feet parallel to each other; make sure the rear heel stays on floor. Switch legs and repeat. Variation: keep rear knee slightly bent during stretch. This will stretch the soleus, a flat muscle underneath the gastrocnemius, the major calf muscle.
Ankle Sprain Prevention
Preventive measures are unusually rewarding, since people who sustain an ankle injury once are nearly twice as likely to re-injure themselves.
- Stretch. Before and after exercising, stretch your calf muscles using the exercise illustrated below. Tight calf muscles pull on the Achilles tendon, attached to the heel bone, and can cut down on the range of motion in your foot, thus sometimes promoting twisted ankles.
- Wear supportive shoes. When you’re on your feet, especially if you’re walking, wear stable shoes that offer some support. Replace or repair rundown heels and soles. Avoid platform soles and high heels, or any shoe that throws the foot off balance. Open shoes and sandals, which are less stable than other footgear, are a poor choice if you’re trying to avoid ankle injury.
- Exercise regularly. Sedentary people are more likely to experience a sprain than those with strong muscles.
- Strengthen your legs. Start with heel raises: stand with your feet comfortably apart; rise on the balls of your feet as far as possible, hold for a few seconds, then lower. Gradually work up to 20 repetitions. Eventually try this exercise while standing with the balls of your feet on the edge of a step or a book, so that you carefully dip your heels lower than your toes. Alternate these with toe raises: wearing flat shoes with smooth soles, stand on your heels and keep your toes as high off the ground as possible; walk like this, keeping your toes elevated, for three to five minutes. Also try walking on the insides of your feet, then the outsides.
Beyond Home Remedies: When To Call Your Doctor
If you heard a pop, if the ankle looks abnormally bent, or if the swelling is severe and the skin discolored, you should suspect a severe sprain or fracture and contact your physician or go to an emergency room. Don’t aggravate the sprain by flexing your ankle or putting weight on it.
Contact your physician if you initially suspected a mild sprain but find you can’t put any weight on it after 36 hours of self-treatment. Also contact your doctor if you are having severe pain or swelling.
What Your Doctor Will Do
Your physician will review how the injury occurred and examine the ankle. X-rays may be taken to determine if a bone has been broken. Depending on the severity of the injury, your ankle may be taped or put in an air cast for several weeks. Anti-inflammatory medications may be prescribed.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media