What are the treatment options for ankle sprains?

Photo of a physiotherapist treating a sprained ankle (PantherMedia / Wavebreakmedia ltd)

If someone sprains their ankle, the ankle is first immobilized (kept still) for a while using an ankle brace or bandage. But it's usually possible to start doing rehabilitation exercises quite early on. Painkillers can be used to relieve pain. Surgery is only rarely needed.

Sometimes one awkward step is all it takes for your foot to twist sideways, resulting in an ankle sprain. This is an injury where the ligaments around the ankle are overstretched or torn. Severe sprains can make the ankle joint chronically unstable.

Ankle sprain: What can you do?

In the first few days after an ankle injury, people are usually advised to rest their foot, keep it elevated, cool their ankle and use a compression bandage. Resting your foot for a while at first can help reduce the swelling and pain. But if the ankle sprain isn't severe, there are good reasons to already start doing suitable exercises very early on.

Cooling your ankle with an ice pack may provide some pain relief. There isn't much research on how effective cooling the ankle is. If you feel that cooling helps, there is little reason not to. But ice cubes or ice packs should not be placed directly on your skin because this could lead to a cold burn.

According to studies, compression bandages can help in the healing process. Compression bandages are elastic bandages that are wrapped around the foot, from the tips of the toes to above the ankle, to apply gentle pressure. This is best done by a medical professional, to make sure it isn't too loose or too tight.

When can you put weight on your foot again?

If the ligaments in a sprained ankle have only been overstretched, the ankle usually gets better within a few days: Immobilizing your ankle with a bandage or ankle brace and resting your foot will then be enough. You can soon carefully put weight on the foot again. If it's a mild sprain, you should be able to walk normally again after about one week.

If ligaments are torn or partially torn, it can take weeks before you are able to use your foot normally again. Then you will probably have to wear an ankle brace or orthotic (device for aligning your ankle) for at least five weeks, to stop you from moving your ankle too much. The idea is to allow the ligaments to rest, so that they can grow back together again. If there is a lot of swelling, a cast and crutches may be necessary to reduce the strain. Injections to prevent blood clots may be a good idea if mobility is very restricted, or limited for a long time.

Does physiotherapy help?

If you have a torn or partially torn ligament, doing strengthening exercises can help to stabilize your foot before you start walking again. Many of these exercises are done to strengthen the muscles and improve coordination. They involve things like stretching and bending the foot in different directions. The earliest time to start physiotherapy will vary from person to person. But it is often possible to start after about two or three weeks.

People who do mobilization exercises can often get back on their feet again faster than people who keep their foot immobilized in an ankle brace for a long period of time. They can start doing sports again sooner too. Starting exercises earlier probably doesn't have any influence on the long-term stability of the ankle, though.

Sometimes physiotherapists or doctors offer ultrasound therapy or electrotherapy in addition to conventional treatments. These are meant to speed up the healing process. But studies haven't shown that they have any additional benefits.

What helps to relieve the pain?

At first, it helps to rest the foot for a few days and – depending on how severe the injury is – put no or only a little weight on it. If this is not enough, painkillers can help. These include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac and ASA (the drug in medicines like Aspirin). Some medications can be used in the form of ointments or tablets, both of which have been shown to temporarily reduce pain and swelling.

One advantage of ointments is that they don't pass through the stomach. Painkillers that are taken as tablets can damage the lining of the stomach. The longer you take them and the higher the dose, the more likely this is to happen. But people who have a sprained ankle usually only need to take painkillers for a short time.

There are also herbal ointments for pain relief, but they haven't been proven to help.

What are the advantages or disadvantages of surgery?

Torn ligaments can be sewn back together again. But this operation doesn't usually help people get back on their feet again any sooner than if they start doing mobilization exercises early on. And it is associated with particular risks, including nerve damage and – like after any operation – infections, bleeding and wound healing problems.

People who do competitive sports sometimes choose to have surgery in the hope that it will help them recover fully sooner. But there is no scientific evidence that this is actually the case. Instead, research suggests that people who have physiotherapy and do strengthening exercises are able to do sports again sooner.

Surgery can sometimes be a good idea for people with particularly severe ankle injuries, though. If the ankle is still unstable six months after it was sprained, doctors might suggest surgery. This involves shortening the ligaments to stabilize the ankle. Ligaments that are operated on for this reason are probably more stable in the long term.

Starting to do exercises and coordination training sooner rather than later is also a good idea after surgery for an unstable ankle. This will probably allow you to return to your usual everyday activities sooner than if you keep your ankle immobilized in a brace for a long period of time.