How do ankle sprains happen?

There are different ways that you can sprain your ankle. It’s most likely to happen if you suddenly twist your foot too far inwards (an inversion sprain). This can make the ligaments on the outside of your ankle stretch past their normal range and sometimes tear. Ligaments are bands of fibrous tissue that connect one bone to another, supporting your joint. Sometimes more than one ligament is affected. Occasionally, a sprain can affect the bones around your ankle joint too.

Sprained ankle grades

Sprained ankles can be graded to describe how bad the injury is.

Grade I. A mild sprain, which happens when you overstretch a ligament. You may have mild swelling, bruising and pain around your ankle, but you should be able to put some weight on your foot.
Grade 2. A moderate sprain, which happens when you overstretch and partially tear a ligament. You may have quite a lot of swelling, bruising and pain around your ankle, and you may find it difficult to put weight on your foot.
Grade 3. A severe sprain, which happens when you completely tear a ligament. The swelling, bruising and pain around your ankle are usually very bad. Your ankle may feel quite unstable (wobbly) and you won’t be able to put any weight on your foot without a lot of pain.

What causes a sprained ankle?

Sprained ankles are often associated with doing sports, especially those that involve sudden changes in direction or where you may jump and land awkwardly. These include football, basketball, volleyball and climbing. But ankle sprains are not always linked to sport – you can sprain your ankle doing everyday activities too. There are certain things that can increase your risk of spraining your ankle.

Being new to a sport or not having trained properly.
Not warming up properly before you exercise.
Wearing unsuitable footwear, which may make you more likely to go over on your ankle.
Not exercising regularly, which means your muscles and joints may be weaker and more prone to injury.
Having poor co-ordination or balance.
Being underweight.

If you’ve sprained your ankle before, you’re more likely to do it again. This is because your ankle ligaments may be weaker even after they’ve healed.

Symptoms of a sprained ankle

Your symptoms will depend on how bad your injury is. They may include:

pain
swelling
bruising
restricted movement
difficulty putting weight on your foot or more pain when you do
you may feel unstable (your ankle feels wobbly when you try to stand on it)

When should I seek medical help?

You don’t always need to seek medical help for a sprained ankle. You can usually treat a mild ankle sprain by following some self-care measures at home. See our section on self-help below for more information on this. But if your sprain is very bad, you may need medical attention. It’s possible you may have damaged other parts of your ankle such as the bones or tendons. And it can be difficult to distinguish between a very bad sprain and a fracture (broken bone) without an X-ray.

Seek medical attention straight away if your ankle is too painful to stand on, seems deformed or your skin is broken. You can usually go to an urgent treatment centre or minor injury unit for injuries like these, but phone NHS 111 if you’re not sure. You should also have your ankle checked out if the pain and swelling don’t improve or they get worse after a few days.

If you keep spraining your ankle or it feels unstable, make an appointment to see your GP or a physiotherapist.

Diagnosis of a sprained ankle

A doctor, physiotherapist or other qualified musculoskeletal health practitioner will usually be able to diagnose a sprained ankle by asking about your symptoms and examining you. They’ll ask exactly how you hurt your ankle and if you could stand and walk afterwards. When they examine you, they’ll check for pain, swelling and bruising around your ankle. They may also check how much you can move your ankle and if you can put any weight on your foot.

If your injury is particularly bad, your doctor or physiotherapist may recommend you have an X-ray to check whether or not your ankle is broken. Sometimes, they may also arrange ultrasound or MRI scans if they need a more detailed look at your ankle.

Treatment of a sprained ankle

Sprained ankle treatment aims:

reduce pain
reduce swelling
get your ankle back to its usual range of movement as soon as possible.

Medicines for a sprained ankle

You can take certain over-the-counter painkillers such as paracetamol or ibuprofen to help ease your ankle pain. You can get ibuprofen gels and creams that you apply to the skin over your ankle – you may find these helpful.

If over-the-counter painkillers don’t help, your doctor may offer you a prescription for stronger pain relief. Always read the patient information that comes with your medicine. If you have questions, ask your pharmacist or doctor for advice.

Exercise and movement for a sprained ankle

You may need to briefly rest your ankle after you’ve injured it. But it’s usually best to start moving it again and do some gentle exercises as soon as you can. This will help your ankle to get back to normal more quickly than keeping it still. Your doctor or physiotherapist may give you something to protect your ankle while you’re moving it, like a brace or splint, if you need it.

If you have a particularly bad sprain, your doctor or physiotherapist may advise you to wear a cast, splint or brace to immobilise your ankle (stop it from moving) for a few days. This may help to reduce any pain and swelling around your ankle. You’ll be advised to start moving and exercising your ankle once the period of immobilisation is over.

If you’re at all worried about doing exercises or feel any pain, stop and speak to a doctor, nurse or physiotherapist before continuing. If you’re not sure when and how to start exercising your ankle, you can check this with a doctor or physiotherapist.

Rehabilitation for a sprained ankle

You don’t always need physiotherapy or osteopathy for a sprained ankle. But if your sprain is very bad or isn’t getting better after a week or so, you may benefit from seeing a physiotherapist or osteopath. You can often book an appointment with a physiotherapist directly, without needing to see your GP. This is known as self-referral. Ask at your GP surgery to see whether or not this is available in your area.

A physiotherapist can develop a formal exercise programme for you which will involve co-ordination exercises and balance training. It will aim to build your strength and mobility while getting back the full range of movement in your ankle. Having strong ankle muscles and joints may mean you’re less likely to sprain your ankle again. It’s important to stick to the exercise plan your physiotherapist recommends. This will help to make sure your ankle is back to full strength before you return to any sports or high impact activities.

Surgery for a sprained ankle

It’s very unlikely you’ll need to have surgery for a sprained ankle. But if your ankle is badly sprained or isn’t getting any better, your GP may refer you to an orthopaedic surgeon for assessment. They will advise whether or not surgery may be beneficial for you. You’re more likely to need surgery if you play sports or are an athlete at a professional level.

Recovering from a sprained ankle

How long it takes for you to recover will depend on how bad your sprain is. Mild-to-moderate sprains should heal enough to walk on within a few weeks. But it may take up to two or three months to get back to normal, including playing sports. If you have a very bad ankle sprain, it may take several months to recover, especially if you need surgery. There’s a risk of injuring your ankle again, especially in the first four to six weeks.

Although the pain in your ankle may have eased, you should wait until you have full range of motion and have rebuilt the strength in your ankle. If you start too soon, you may hurt your ankle again, which may lead to long-term problems. Ask your doctor or physiotherapist when you can safely take up your normal activities again, including sports.

Prevention of a sprained ankle

There are things you can do to reduce your chances of spraining an ankle or injuring it again if you’ve recovered from a sprained ankle. This includes keeping the muscles around your ankle as strong and as flexible as possible. Some other things you can do are listed below.

Wear shoes that are suitable for the activity you’re doing and are in good condition. Wearing high-heels can be risky, especially on uneven ground.
Try to do some exercises that incorporate strength and flexibility training, as well as cardiovascular fitness. And make sure you have days off from doing intense exercise.
Take care when you’re walking or running on uneven surfaces – exercise on even surfaces if you can.
Warm up and stretch your muscles before playing sport, and cool down afterwards.
During certain activities it may help to wear high-top shoes (ones that go above your ankle), an ankle brace or ankle tape, especially if you’ve had a previous injury.
Stay a healthy weight for your height – sprains are more likely if you’re very overweight or are underweight.