A sprained ankle (ankle sprain) is a stretch or tear of the ligaments of the ankle joint, most often after the foot rolls inwards. It affects the ligaments on the outer side of the ankle and is one of the most common injuries of all, in sport and in everyday walking. It ranges from a mild stretch that lets you walk the same day to a complete tear of the ligament. If it doesn’t recover fully, the ankle is often sprained again.
Symptoms
- Pain on the outer side of the ankle straight after the roll.
- Swelling that gets worse over the first hours.
- Bruising that after a day or two may spread down to the foot and toes.
- Pain when putting weight on the foot and walking.
- A feeling of instability: the ankle gives way on uneven ground.
- Stiffness, especially in the morning and after sitting.
- Pain when you turn the foot inwards.
How bad the pain is at first doesn’t always show how serious the injury is. A better sign is whether you can put weight on the foot and how quickly the swelling appears. Bruising looks alarming but doesn’t by itself mean a fracture.
Why it happens
- Stepping awkwardly: on an uneven surface, on a kerb or on another player’s foot.
- Sports with jumping and changes of direction: basketball, volleyball, football.
- High-heeled shoes or shoes that give the ankle no support.
- An earlier sprain, after which the ligaments and balance haven’t recovered.
- Tiredness at the end of a training session or a long day.
- Weak lower leg and thigh muscles.
After a sprain, the ankle’s sense of its own position in space is also affected, so it reacts more slowly on uneven ground. This is exactly what balance exercises train.
How we treat it
Bring your X-rays if you have had any. Kaloyan checks the ligaments, the swelling and how you put your foot down, and decides whether an X-ray is needed to rule out a fracture. In the first days the aim is to bring down the swelling and pain. Kinesio taping supports the ankle while you return to walking, and ultrasound therapy helps the irritated tissues around the ligaments.
Next come exercises for mobility, for the strength of the lower leg muscles and, most importantly, for balance. It is balance exercises that reduce the risk of another sprain. For a mild sprain, 3–5 visits are usually needed, and more for a more severe one. If a cast or a walking boot was needed, recovery continues as kinesitherapy for injuries, and after surgery on the ligaments as post-operative rehabilitation. Either way, there is more time for mobility and gait. At the end, Kaloyan checks that you can jump, run and change direction without pain before you go back to sport. If you play sport, he will also tell you when a brace or tape during training makes sense.
What you can do yourself
- For the first 2–3 days: cold for a short time several times a day, and your foot raised above the level of your heart.
- Put weight on the foot as far as the pain allows. Complete immobilisation usually slows recovery.
- Move your foot up and down while you sit or lie, so the ankle doesn’t stiffen.
- Wear sturdy lace-up shoes, not slippers, until the ankle has healed.
- Don’t go back to sport until you can jump and stand on one leg without pain.
When to see a doctor first
These signs mean you need an X-ray to rule out a fracture:
- you can’t take four steps after the injury;
- it hurts when you press on the bone at the back of the ankle or on the outer edge of the foot, halfway along;
- the foot is numb, cold or blue;
- the ankle is deformed;
- the pain and swelling haven’t eased after a week.
