What are the treatment options for ankle sprains?

In the first few days after an ankle injury, people are usually advised to rest their foot, keep it elevated (raised), 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 shouldn't be placed directly on your skin because that 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.

“Kinesio tape” hasn’t yet been proven to help. This stretchy sticky tape moves with your body, and is thought to stimulate the muscles and nerves while moving.

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.

If you have a torn or partially torn ligament, doing strengthening exercises can help to stabilize your foot before you start walking again. And they reduce the risk of spraining your ankle 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. Common approaches include neuromuscular training and proprioceptive training. Both forms are similar and include, for example, foot exercises, single-leg stands, weight shifts, and strength training. The earliest time to start physical therapy will vary from person to person. But it's 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 physical therapists 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.

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 isn't enough, painkillers can be used temporarily to 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 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 and homeopathic ointments for pain relief, but these have not been proven to help.

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 the procedure is also associated with particular risks, including nerve damage and – like after any operation – infections, bleeding and wound healing problems. That is why surgery is only rarely beneficial.

People with severe ligament tears sometimes opt for this type of surgery shortly after the injury, hoping to return to full activity more quickly – for example, competitive athletes. But it isn’t clear whether this actually helps.

Surgery is more likely to be considered if the ankle remains chronically unstable after a sprain despite physical therapy. 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.