Ankle Sprains: Symptoms, Treatment and Recovery

An ankle sprain is an injury to one or more ligaments around the ankle. Ligaments are strong bands of connective tissue that connect one bone to another and help stabilise joints.

When the foot twists beyond its normal range, the ligaments become stretched or torn. The most commonly injured ligaments are on the outside (lateral side) of the ankle.

The lateral ligament complex consists of three ligaments:

Anterior talofibular ligament (ATFL) — the most commonly injured ligament, usually torn when the foot rolls inward.

Calcaneofibular ligament (CFL) — often injured with more severe sprains.

Posterior talofibular ligament (PTFL) — rarely injured except in major trauma.

Common causes include sport — particularly football, rugby, netball, basketball, running and hiking — as well as slipping on uneven ground, missing a step and falling awkwardly.

Most injuries occur when the foot suddenly rolls inward (an inversion injury).

Typical symptoms include sudden pain, swelling, bruising, difficulty walking, tenderness over the ligaments and reduced movement. Some people hear or feel a “pop” at the moment of injury.

Not everyone needs an X-ray. Doctors often use the Ottawa Ankle Rules to decide whether an X-ray is necessary. An X-ray is usually recommended if there is bone tenderness, an inability to bear weight, or concern about a fracture.

Many ankle sprains have completely normal X-rays, because ligaments do not show up on standard X-rays.

Ligaments heal in three overlapping stages. Understanding where you are in that process helps set realistic expectations.

Most modern guidelines recommend protecting the ankle, resting relatively rather than completely, and using ice, compression and elevation to control pain and swelling.

Avoid another twisting injury. Use a supportive shoe, brace or boot if advised.

Avoid high-impact activity, but continue gentle movement.

Apply wrapped ice for around 10–20 minutes every few hours during the first couple of days to reduce pain and swelling. Never place ice directly onto the skin.

Some clinicians recommend compression sleeves or bandages. Evidence that they improve healing is limited, although many people find them comfortable.

Raise the ankle above heart level whenever possible during the first few days. This helps reduce swelling.

Yes — if you can. Modern research consistently shows that early weight-bearing is usually better than prolonged immobilisation. Walking encourages circulation, ligament healing, reduced stiffness and faster recovery.

You may need crutches initially if walking is very painful, but most people should gradually increase weight-bearing as comfort allows. NHS guidance notes that early weight-bearing generally helps ankle sprains heal more quickly.

Simple painkillers are usually sufficient, such as paracetamol or ibuprofen where appropriate. Always follow the advice on the packaging or from your healthcare professional.

Rehabilitation is the most important part of recovery. Without it, the ankle remains weak and unstable.

Move the ankle up and down, in and out, and in circles. Repeat several times each day.

Progress to calf stretches, heel raises, towel stretches and walking normally.

Balance exercises retrain the muscles that protect the ankle. Examples include standing on one leg, balancing with your eyes closed, balancing on a cushion and wobble board exercises. These are among the most effective ways to prevent future sprains.

Before returning to competitive sport you should have full movement, full strength, no swelling, and be able to hop, run and change direction comfortably.

Progress in steps: walking → jogging → running → training → competition.

Almost never — most ankle sprains heal without surgery. Surgery may occasionally be considered if repeated ankle instability persists, multiple sprains continue despite physiotherapy, large ligament injuries fail rehabilitation, or associated cartilage injuries are present.

Most people recover well. Occasionally problems include chronic instability, repeated sprains, persistent swelling, stiffness, cartilage injury and tendon injury.

Persistent pain beyond 8–12 weeks should be reviewed by a healthcare professional.

Seek urgent assessment if you have severe deformity, an inability to bear weight immediately after injury, numbness, a cold or pale foot, severe pain that is getting worse, increasing redness or fever, or significant calf swelling or chest pain (which could indicate a blood clot).

Usually yes, provided you can tolerate it and gradually increase weight-bearing.

Most swelling settles over 6 weeks, but mild swelling may persist for several months.

A brace can provide comfort and support in the early stages or when returning to sport, but it should not replace rehabilitation exercises.

Only drive when you can comfortably perform an emergency stop and fully control the vehicle without pain or restriction.

Once you have sprained an ankle, your risk of another sprain increases. Balance and strengthening exercises can significantly reduce this risk.