Ankle sprain is one of the most common ankle injuries. Every day in the U.S., 25,000 people sprain their ankle. And more than 1 million people visit emergency rooms each year because of ankle injuries. The most common ankle injuries are sprains and fractures, which involve ligaments, tendons, and bones in the ankle. Inversion, where the foot rolls onto its outside edge, is the main mechanism of ankle sprain. This page will focus on muscle sprains, the type of sprain that typically happens when a person accidentally turns or twists their ankle in an awkward way.
A study from The Journal of Bone & Joint Surgery found that nearly half of all ankle sprains happened during athletic activity, such as basketball (41.1%), soccer (7.9%), and football (9.3%).1 But this means that half of all sprains occur during everyday activities. Tripping on stairs, taking an awkward step, stepping off the curb incorrectly, all can lead to an ankle sprain.
While many people will say that “it’s just an ankle sprain,” research shows that these injuries need focused attention for rest and recovery to avoid re-injury or long-term challenges. With proper treatment and rest, most ankle sprains heal within 4-6 weeks. In severe cases with torn ligaments that require surgical repair, it may take 12 weeks or more to recover with a
post-operative plan outlined by their surgeon.
Ankle Sprain: The RIPE Treatment
The first treatment for an ankle sprain is to calm the inflammation/swelling and control the pain. The first aid treatment is called RIPE (Rice, Ice, Painkillers, and Elevation).
- Rest: The most important reason to rest after an ankle sprain is to avoid further damage by continuing to do weight-bearing activities. Resting means avoiding weight-bearing as much as possible. Avoid strenuous activities, such as jumping and running, until it’s possible to walk without feeling pain in the injured ankle. Resting is what allows the body to start the healing process.
- Ice: An ice slush bath or use of ice is recommended immediately after an ankle sprain; keep the ice in place for 15 to 20 minutes; then, repeat every 2 – 3 hours while awake. After 2 – 3 days, an ice pack can be used 3 times per day until the swelling goes down.
- Painkillers: Over-the-counter painkillers, such as ibuprofen or acetaminophen/paracetamol, are sometimes enough to manage the pain caused by a sprained ankle. Managing the pain allows the individual to be more mobile.
- Elevation: Keeping the injured ankle raised above the level of the hips is helpful to ease ankle sprain pain and decrease the swelling. Patients are advised to do this in the first few days after their injury.
Support As Prevention
Today’s footwear comes in all shapes and sizes with manufacturers making modifications to support their branding, meaning a size 10 foot may need a size 9 shoe in Brand A, a size 10 shoe in Brand B, and a size 9.5 wide in Brand C. Best practice is to always have feet sized with a professional shoe gauge device to confirm shoe size; best time to measure is later in the day, when gravity has taken its toll. Look for shoes with appropriate arch support and support level based on how the shoe will be used.
While there is debate, some studies suggest that wearing high-top shoes (collar over the ankle) can support the ankle because the foot inverts less (inversion, where the foot rolls onto its outside edge, is the main mechanism of ankle sprain), according to Sara Lyn Miniaci-Coxhead, MD, an orthopedic surgeon with the Cleveland Clinic.2,3 However, other studies suggest that high-top shoes do not prevent excessive foot inversion in a dynamic situation.4 Each person has to find what footwear works for them.
Depending on the severity of the injury, an orthotic—a prescription shoe insert that can provide arch support and other individualized foot correction—may be recommended. These custom-made devices are typically prescribed and designed by podiatrists. Orthotics are usually a part of a treatment regimen for many ongoing ankle concerns.
Over-the-counter shoe inserts, such as those sold in retail stores, may offer additional cushioning and some level of arch support or heel reinforcement, but are not customized to correct long-term anatomical issues.
Ankle braces also come in both custom prescription versions (available from clinicians) and over-the-counter. They do offer support without blocking flexibility, but fit is critical—is the ankle getting the support it needs? Or is the arch getting all the support, leaving the ankle vulnerable? Because most come in basic small, medium, and large sizes, be prepared to try 2 or 3 to find the 1 that fits properly. Ankle splints are prescription devices to facilitate healing an injury and are not advised for everyday use, unless prescribed by a clinician.
In fact, having strong muscles is more important than any brace or shoe, especially on the evertors or outside of the foot.
Although each person’s body and recovery differ, recovery stretches and safe exercises typically should be started within a few days after the ankle sprain.
If there is no pain, motion exercises can be started to loosen the ligaments and muscles in the ankle without putting too much strain on them.
An effective ankle rehabilitation and exercise that can be done while watching TV or sitting at a desk is the “alphabet exercise.”5 In short, trace or draw the alphabet using the big toe. Avoid movement in the hip or knee by stabilizing the thigh.
Another exercise is towel curls. While sitting, put a towel on the floor, then use the toes of the injured foot to scrunch the towel toward you. Then, again using the toes of the injured foot, push the towel away. To make the towel curls exercise more challenging, you may place a weighted object, like a can, on the other end of the towel.
A third exercise, also done while seated, involves the knee of the injured side: Slowly move the knee side to side while feet remain pressed flat. Do this range-of-motion exercise for 2 to 3 minutes.
Once pain in the ankle has calmed, begin stretching the Achilles tendon. This band of fibrous tissue connects the muscle on the back of your lower leg to the heel bone (the calcaneus).
To do calf stretches, stand facing the wall. Put hands on the wall, at eye level. Then, take a step back with the leg to be stretched. Bend front knee while keeping back heel on the floor and hold this stretch for about 15 to 30 seconds. Repeat this stretching exercise 2 to 4 times.
This exercise stretches the muscles at the back of the lower leg as well as the Achilles tendon and a recent study demonstrated how calf muscle stretching increased ankle joint dorsiflexion – the backward bending and contracting of the foot.6
Strengthening exercises should be started only when the clinician advises. As a precaution, it is best to talk to your physical therapist or doctor about the timing to start the strengthening exercises although it commonly starts when you can already stand without increased swelling or pain.
One simple strengthening exercise can be while seated and with feet flat on the floor. Begin by pushing the side of the injured foot outward against an immovable object, like heavy furniture or a wall. Hold this position for about 6 seconds and then relax; repeat 8-12 times. This exercise will improve ankle inversion.7
For resistance, try using a rubber tubing or resistance band. Loop the band around the injured foot and push the foot out to the side against the tubing/band. Count 1 to 10 while gradually bringing the foot back toward the middle.8
Heel-toe walking may also be advised by clinicians to assess the ankle’s ability to maintain balance and bear weight.9
Remember that even after the ankle feels better, it is important to still continue with the stretching exercises to prevent re-injury and keep the ankle strong. In fact, a well-known study linked re-sprain in the first 3 months after initial ankle sprain to incomplete recovery.10
Best advice: Take the time to fully heal and strengthen the ankles to achieve good recovery and prevent re-injury.
Nathan Lloyd, MSc, is a licensed personal trainer based in Boulder, Colorado. He helps his clients through his online or in-person personal coaching programs at ONE Boulder Fitness Gym. In his spare time, he loves to write about his favorite gym equipment at ExpertFitness.org.
- Waterman R, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279-84.
- What’s the Best Way to Support Your Ankles During Exercise? Cleveland Clinic Foundation. May 25, 2021. Available at https://health.clevelandclinic.org/can-high-top-shoes-help-avoid-ankle-sprains/. Accessed Sept. 15, 2021.
- Ricard MD, et al. Effects of high-top and low-top shoes on ankle inversion. J Athl Train. 2000;35(1):38–43.
- Fu W, et al. The effect of high-top and low-top shoes on ankle inversion kinematics and muscle activation in landing on a tilted surface. J Foot Ankle Res. 2014;7(1):14.
- Harvard Health Publishing. The “alphabet exercise” for foot and ankle strength. May 2020. Available https://www.health.harvard.edu/staying-healthy/the-alphabet-exercise-for-foot-and-ankle-strength. Accessed Sept. 15, 2021.
- Macklin K,et al. The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters. Foot (Edbin). 2012;22(1):10-17.
- Chinn L, Hertel J. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010;29(1):157–167.
- Han K, et al. Effects of a 4-week exercise program on balance using elastic tubing as a perturbation force for individuals with a history of ankle sprains. J Ortho Sports Phys Ther. 2009;39(4):246–255.
- Mattacola CG, Dwyer MK. Rehabilitation of the ankle after acute sprain or chronic instability. J Athl Train. 2002;37(4):413–429.
- van Middelkoop M, et al. Re-sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: an observational study. J Physiother. 2012;58(3):181-18.