Rolling, twisting or turning an ankle in an awkward way can stretch or tear the ligaments in the joint, which is a sprain, and depending on the type of injury, many sports injuries can be treated at home with rest, ice, compression and raising the injured part, though a severe injury needs a health care provider. You can check your own ankle against the signs below, by looking at it and by how it takes your weight, to decide between home care, your own doctor's office and an emergency room.
Signs the ankle needs an emergency room or your own doctor
Go to a hospital emergency room right away, or call 911, if any one of these is true:
- you think you have broken a bone
- the joint looks out of position
- the injury is serious, or the pain is severe
- you heard a pop and had problems using the ankle immediately
Go for severe pain even if you can still stand on the ankle.
Contact your own doctor's office if any of these is true:
- you cannot walk on the ankle, or walking is very painful
- the ankle becomes numb or tingly, feels cold, or the feeling in it changes
- it keeps getting more discolored, red or black and blue
- the swelling has not started to go down within 2 days of the injury
- you have signs of infection, such as red, warm and painful skin or a fever over 100°F (38°C)
A sprain can be anything from stretched ligaments, which may be slightly torn, to ligaments torn all the way through. Partly torn ligaments may need a splint or another device that keeps the ankle still, and fully torn ones will likely need a brace, splint or cast for several weeks and may need surgery, especially in younger or more active people. A provider who examines the ankle may order an x-ray to look for a broken bone, or an MRI scan to look for an injury to the ligament.
Rest, ice and a raised foot for two days, then weight back on it
Until about 48 hours have passed, keep your weight off the foot and rest it, raised on a pillow at or above the level of your heart, which helps bring the swelling down. For the first 24 hours after the injury, ice it every hour while you are awake, 20 minutes at a time, with the ice covered by a towel or bag and never directly on your skin. After the first 24 hours, ice it for 20 minutes 3 to 4 times a day, leaving at least 30 minutes between sessions.
Pressure from a wrap may help reduce swelling, and an elastic bandage works well as long as it is not wound so tightly that it cuts off the circulation. If the ankle goes numb, tingly or cold with a wrap on, loosen the wrap and contact your doctor's office, since those changes are on the list above. Leave heat for later. Used straight after an injury it tends to increase inflammation and swelling, and it can be used to relieve muscle tension once 72 hours have passed, not before.
The pain and swelling of an ankle sprain most often get better within 48 hours, and from then you can begin to put weight back on the foot. Put on only as much as is comfortable at first, work up slowly to your full weight, and stop and rest if the ankle begins to hurt, since carrying on with a movement that hurts may cause further harm. If a provider has already seen it and given you crutches, a brace or a splint, or asked you to keep part or all of your weight off it, follow that instruction first.
After a less severe sprain you may be able to go back to your normal activities after a few days, and after a more severe one it may take several weeks. Ask your doctor's office for exercises to strengthen the foot and ankle, which can help prevent future sprains and long-lasting ankle pain, and ask there too before you go back to harder sport or physically demanding work.
A previous injury is among the risk factors for sports injuries, and so are shoes without enough support and taking certain medicines, such as fluoroquinolones, a class of antibiotics linked to tendinitis and tendon rupture, which affect tendons rather than the ligaments a sprain involves. Once the ankle has healed, keep up some kind of regular exercise, choosing activity that suits your fitness and raising the intensity gradually, which lowers the chance of a serious injury. If a knee already aches when you start back, build up just as gradually (see Can you start moving when your knees already hurt?).
Over-the-counter pain medicine, and what to check before taking it
Ibuprofen or naproxen, both sold without a prescription, may help ease the pain and swelling of an ankle sprain, and acetaminophen, sold as Tylenol and under other names, may be taken after the injury if your doctor's office says it is safe to do so. The check before each one is different:
| Medicine | Before you take it |
|---|---|
| ibuprofen or naproxen | talk with your doctor's office first if you have heart disease, high blood pressure, kidney disease or liver disease, or have had stomach ulcers or internal bleeding in the past |
| acetaminophen | do not take it if you have liver disease; otherwise ask your doctor's office first whether it is safe for you |
Read the warnings on the label of any medicine before you take it (see Taking cold medicine and a pain reliever? Check both labels).
According to MedlinePlus, ibuprofen and naproxen may each harm the fetus and cause problems with delivery if taken around 20 weeks or later in pregnancy, and neither is to be taken around or after 20 weeks unless a doctor has said to. If you are pregnant, planning a pregnancy or breastfeeding, tell your doctor's office before taking either one.
People taking either medicine may have a higher risk of a heart attack or stroke, and either may cause ulcers, bleeding or holes in the esophagus, stomach or intestine; both kinds of problem may happen without warning and may cause death. If you have chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech while taking one, get emergency medical help right away: call 911. Stop the medicine and contact your doctor's office if you have stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools. Neither is meant to be taken with another pain medicine unless a doctor has said so.
How long to give the ankle before you contact your doctor's office
Contact your doctor's office if the ankle does not feel any better after 5 to 7 days. Do not wait that long if ice, rest and pain medicine have done nothing for the pain, or if the ankle keeps feeling weak or giving way easily: contact the same office then. Some ankle sprains may become long-lasting, leaving an ankle that stays painful and swollen, or weak and quick to give way.
Contact that office as well if the pain has not gone away after several weeks, even if it has been getting better. Most of the time a mild sprain heals in 7 to 10 days, while after a bad sprain the pain and swelling may take several weeks to go.
Partly and fully torn ligaments often come with torn small blood vessels, which let blood leak into the tissue and turn the area black and blue. That blood may not show for several days, and most of the time it is absorbed within 2 weeks. An ankle that keeps getting more discolored is on the doctor's-office list near the top of this article.
If you found your weight-care physician through NicoCares, let the care team know about the sprain, and about any pain medicine you start for it, with a note in Spruce, the messaging service where that team answers you. NicoCares states no time for a reply there, so take every warning sign in this article, in the ankle or from a pain medicine, to your own doctor's office, an emergency room or 911.
