This is the final article of a three-part series where Dr. Jeremy M. Saller answers common questions about ankle sprains, from the injury to diagnosis and treatment. Dr. Saller specializes in the treatment of foot and ankle issues.
From simple at-home remedies to a rehabilitation plan, ankle sprains can require a wide range of treatments. It’s best to let a medical professional assess your injury to determine the right treatment plan, even if you think you can just “walk it off.”
How is an ankle sprain treated?
Most ankle sprains, even severe sprains, do not require surgical treatment if addressed appropriately. The treatment that is recommended is based on the grade of the sprain.
For all grades of ankle sprains, the first thing to do is to follow the R.I.C.E. protocol.
- Rest: Try not to walk on the ankle until it is comfortable to do so.
- Ice: Ice will help constrict the small blood vessels around the ankle to help control swelling. When using ice, place a cloth over the ankle and place the ice pack over the cloth. Limit the ice bag application to 20 to 25 minutes at one time.
- Compression: A compressive elastic bandage around the ankle with help control swelling and provide a little bit of support.
- Elevation: Elevating the ankle above the heart for the first 48 hours will help limit the amount of swelling by allowing blood to flow back to your heart more easily.
For Grade 2 ankle sprains, a support ankle brace is often needed to provide support to the damaged ligaments.
For Grade 3 ankle sprains, a walking boot for several weeks is often recommended to provide additional support and immobilization to the ankle. Because there is a much higher risk of ankle instability with this grade of sprain, early immobilization is often necessary to prevent the ligaments from becoming overstretched. Grade 3 injuries also often require a longer period of rehabilitation.
Nonsteroidal anti-inflammatory medications such as Ibuprofen or Naproxen can help you manage the pain and swelling in the early period.
For grade 2 and grade 3 ankle sprains, physical therapy can be helpful in the recovery process. The physical therapist will help you regain your ankle mobility, strength and balance, which will help decrease the risk of another injury down the road. Physical therapy is often done for in initial period of 4 to 8 weeks.
There are three phases of recovery in an ankle rehabilitation program:
- Phase 1 requires resting the ankle and reducing the swelling (following the R.I.C.E. protocol) to protect the ligaments.
- Phase 2 involves early rehabilitation or physical therapy to help restore ankle range of motion and strength.
- Phase 3 includes more specific strengthening exercises and proprioception training. Proprioception is your ability to “know” where your foot is positioned without looking at it. This normal function is altered after an ankle sprain and must be restored by appropriate balance training. Restoring proprioception around the ankle will decrease the risk of future ankle sprains. In this phase, more sports specific or work specific rehabilitation is done.
Once you have completed your physical therapy program, it is a good idea to continue doing maintenance exercises to keep your ankle strong and flexible to prevent future injuries.
How long does it take an ankle sprain to heal?
The recovery time for ankle sprains is dependent on the severity of the injury.
- Mild sprains (grade 1) can heal in 2 to 3 weeks.
- Moderate sprains (grade 2) usually take about 4 to 6 weeks to heal.
- Severe ankle sprains can take 3 to 6 months to completely heal.
What can happen if my ankle sprain doesn’t heal properly?
If your ankle ligaments do not heal properly, they can become permanently stretched to the point where they do not provide enough support to the ankle joint. This can result in frequent ankle sprains and/or frequent swelling and pain around the ligaments. How do you know if you have developed ankle instability? Here are some signs to look out for:
- Frequent recurrent moderate or severe ankle sprains.
- A continued feeling of instability when walking.
- Problems with instability or pain when walking on uneven ground.
- Persistent weakness in the ankle.
- Frequent severe swelling after normal activities such as walking or light exercise.
- Chronic pain in the ankle.
If you are experiencing these problems, it is best to see an orthopedic surgeon to be properly evaluated. He or she will perform a physical exam to determine the degree of instability of your ankle. New X-rays will often be done to make sure that there is not a missed fracture or an abnormal space at the area of the joint where the ligaments attach. Often in cases of instability, the X-rays will be normal.
The diagnosis will be made by putting together your history (your story about the symptoms you are having), the physical exam findings and advanced imaging tests such as an MRI. The MRI can show the damaged ligaments and any other surrounding structures that may be damaged.
For cases of instability that have persisted for more than 3 months and haven't improved from conservative treatments such as bracing, physical therapy and home exercise regimens, surgery is often needed. The orthopedic surgeon will surgically tighten the damaged ligaments to allow them to work properly. After the surgery, you will need more physical therapy to regain full range of motion in the ankle and strengthen those weak muscles around the ankle.
Want to learn more about ankle sprains? Check out the other two parts of this series:
About Dr. Saller
Jeremy M. Saller, MD, is a board-certified orthopedic surgeon who practices at BayCare Clinic Orthopedics and Sports Medicine in Green Bay, Wisconsin. Dr. Saller specializes in general orthopedic surgery with a special focus on foot and ankle orthopedics and pediatric orthopedics. He joined BayCare Clinic in the summer of 2023.
A note from BayCare Clinic
The content of this article, including text, images, and graphics, is for general informational purposes only. It is not intended to substitute for professional medical advice, including a medical diagnosis and treatment plan.