Sprain Ankle

Diagnosis

To diagnose a sprained ankle, a healthcare professional begins with a physical exam. During the exam, the ankle, foot and lower leg are carefully examined. The skin around the injured area is touched to check for points of tenderness. The foot is gently moved to assess range of motion and to identify which positions cause pain or discomfort.

If the injury appears severe, imaging tests may be recommended to rule out a broken bone or to better understand the extent of ligament damage.

Imaging tests may include:

• X-ray
An X-ray uses a small amount of radiation to create images of the ankle bones. This test is mainly used to rule out fractures.

• Magnetic resonance imaging
An MRI uses radio waves and a strong magnetic field to create detailed cross-sectional or 3D images of soft tissues in the ankle. It is helpful for evaluating ligaments and other soft tissue structures.

• CT scan
A CT scan takes X-rays from multiple angles and combines them to create detailed cross-sectional or 3D images. This test provides more detail about the bones of the joint.

• Ultrasound
Ultrasound uses sound waves to produce real-time images. It allows the healthcare professional to evaluate the condition of ligaments or tendons while the foot is placed in different positions.

Treatment

Treatment for a sprained ankle depends on how severe the injury is. The main goals are to reduce pain and swelling, support healing of the ligament and restore normal ankle function. Severe injuries may require care from a specialist such as an orthopedic surgeon or a physician trained in physical medicine and rehabilitation.

Self-care

For the first two to three days, self-care usually follows the R.I.C.E. method.

• Rest
Avoid activities that cause pain, swelling or discomfort.

• Ice
Apply an ice pack or ice slush bath for 15 to 20 minutes at a time. This can be repeated every two to three hours while awake. People with circulatory problems, diabetes or reduced sensation should consult a doctor before using ice.

• Compression
Wrap the ankle with an elastic bandage to help reduce swelling. The wrap should be snug but not tight enough to restrict blood circulation. Begin wrapping at the foot and move upward.

• Elevation
Keep the ankle raised above heart level whenever possible, especially at night. Elevation helps reduce swelling by allowing excess fluid to drain.

Medications

In most cases, over-the-counter pain relievers are enough to control pain from a sprained ankle. These may include ibuprofen, naproxen sodium or acetaminophen, as advised by a healthcare professional.

Support devices

Walking can be painful with a sprained ankle, so crutches may be needed for a short time. Depending on the severity of the injury, treatment may include an elastic bandage, sports tape or an ankle brace to stabilize the joint. More severe sprains may require a cast or walking boot to keep the ankle immobilized during healing.

Therapy and rehabilitation

Once pain and swelling improve, exercises are introduced to restore ankle movement, strength, flexibility and stability. A healthcare professional or physical therapist guides the progression of these exercises.

Balance and stability training is especially important. These exercises help retrain the ankle muscles to support the joint and reduce the risk of repeat sprains. Activities may include balance challenges such as standing on one leg.

For sports-related injuries, return to activity should be guided by a healthcare professional. Movement and activity tests may be used to determine how well the ankle can handle the demands of a specific sport.

Surgery

Surgery is rarely needed for ankle sprains. It may be considered if the ligament does not heal properly or if the ankle remains unstable despite long-term physical therapy.

Surgical options may include:

• Repairing a ligament that has not healed
• Reconstructing a ligament using tissue from a nearby ligament or tendon