Sprained Ankle: Treatment, Recovery Time and Signs It Might Be Broken

A sprained ankle is one of the most common injuries in the world, and one of the most often mismanaged. Too much rest, too little rehab, and many people end up with a “weak” ankle that keeps rolling. Here’s how to treat it properly and when you need an X-ray.

Imagine stepping off a kerb in the dark and feeling your ankle roll outwards with a sharp pain. Within an hour it’s swollen like a tennis ball and turning purple. You can just about hobble. Is it broken? Do you need A&E? The answer depends on a few simple checks you can do yourself.

Signs it might be broken: get an X-ray

Doctors and nurses often use the Ottawa ankle rules. Get checked urgently if:

• You couldn’t put weight on it and take four steps straight after the injury, or can’t now
• There’s bony tenderness at the back edge or tip of either ankle bone
• There’s bony tenderness at the base of the fifth (little toe) metatarsal, on the outside of the foot, or the navicular bone on the inner midfoot
• The ankle looks deformed, you heard a crack, the foot is numb, cold or pale, or the skin is broken over the injury

First 72 hours: what to do

• Protect the ankle and rest it for the first day or two, but don’t stop moving completely
• Elevate it above the level of your heart when you can
• Ice wrapped in a towel for up to 20 minutes every two to three hours can ease pain
• Compression with a supportive bandage can help swelling (remove it at night)
• Avoid heat, alcohol, running and massage for the first few days, as these can increase swelling
• Paracetamol (acetaminophen) can help pain; check with a pharmacist about anti-inflammatories

How long recovery takes

Most sprains feel much better within two weeks, but ligaments take longer to heal fully. Avoid high-risk sport for around six to eight weeks, and severe sprains can take months. Start gentle movement as soon as pain allows: walking normally, circling the ankle, then calf raises and balance exercises such as standing on one leg.

But why do some ankles keep rolling?

Up to a third or more of people who sprain an ankle have ongoing problems such as pain or repeated sprains, often because balance and strength were never retrained. Studies show a few weeks of balance exercises can cut the risk of spraining it again by around a third or more. See a physiotherapist if your ankle isn’t improving after a couple of weeks or keeps giving way.

Sources: NHS (Sprains and strains), NICE Clinical Knowledge Summary on sprains and strains, American Academy of Orthopaedic Surgeons, Ottawa ankle rules (Stiell et al.). This guide is for general information and does not replace advice from your own nurse, doctor or physiotherapist.