Rehabbing from an Ankle Sprain
One of the most common injuries we see at New Mexico Foot & Ankle Institute is a sprained ankle. These injuries range all the way from a simple twinge to a set of crutches and a cast. The most common sprain is when the foot comes down on an uneven surface and the leg wants to keep going thus “rolling” the ankle. The pain is usually on the outside of the ankle bone and results in immediate pain and swelling. The biggest myth we hear on a regular basis is that you can “walk it off.” After practicing sports medicine for 20 years I have yet to see an injury that was best served by walking it off. All sprains are considered an injury. Most of these injuries involve the ligaments that connect the leg to the foot and they are injured by pulling them further than they are designed to go. This goes from a minor inflammatory response to a complete tear of the ligament. No matter how badly you sprain your ankle there is a very specific way the treatment should go.
Most people have heard the mnemonic RICE. Rest, Ice, Compression, and elevation. The first thing to do with every ankle sprain is to immediately get off the ankle that hurts to stand or walk on. Stop whatever activity you are doing and get off the ankle. If it feels like it doesn’t want to be walked on, then don’t walk on it. The second thing to do with any pain that lasts longer than a few minutes is to apply ice. If there is any swelling this becomes even more important. Heat is not helpful at this stage in the game and will make the swelling even worse. You can safely ice an ankle 20-30 minutes an hour (30 minutes on followed by 30 minutes off). The third thing to think about is getting some compression on the ankle. Using an ace wrap works great. Wrapping the ankle will help with keeping the swelling under control. This is going to be really important when you want to go back to normal shoes and normal activities. The 4th thing to consider is elevation. If it is swollen, put it up.
The first type of sprain is called a grade 1 ankle sprain. These sprains are mild injuries without swelling it’s just a matter of a few hours and the ice and rest do the trick and the next day it is feeling pretty normal. If you had one of these count yourself lucky and make sure you don’t do any side-to-side type movements for the next few weeks while these ligaments heal. Normal walking rarely requires the use of these ligaments that were sprained so people feel pretty good as long as they don’t try and walk on uneven surfaces or turn too quickly.
The second type of sprain is a grade 2 ankle sprain. If the ankle is still sore the day after the injury but you can walk on it and it is only minimally swollen then an over-the-counter ankle brace can be used for the 3-4 weeks it takes for these ligaments to heal. The ankle brace will help compress the area and it fits much better in a shoe than an ace wrap and is much easier to walk on. These types of braces are available at all the local pharmacies and the big box athletic stores. Remember to not push these sprains too hard. Do what is comfortable and don’t return to normal activity until the ankle is fully pain-free. Pushing through the pain or trying to run or exercise on an injured ankle always makes it worse. Knowing the injury can last up to a month for recovery usually helps to keep us patient with the injury.
The third and fourth types of sprain are grade 3 and 4 sprains. These sprains involve partial or full tearing of the ligaments. These are considered moderate to severe sprains and require evaluation by a professional. We don’t necessarily recommend urgent care or emergency rooms since they are good at giving you ice and crutches and can take x-rays if there is a concern for a broken ankle but most of the time they will still refer you to a specialist the next day. Many private podiatry offices like New Mexico Foot and Ankle Institute will get you in for urgent injuries within a day and can also take x-rays and will be able to get you into a walking boot rather than a cast.
The best way to tell between a minor sprain that you can treat at home and a moderate or severe sprain that should be seen is the swelling. If the day after a sprain the ankle is still swollen and looks like a softball or grapefruit on the side of your ankle you need to be seen. The last thing anyone wants is chronic recurrent sprains on that ankle or a sprain that takes 6 months to heal. Moderate and severe sprains can take up to 3 months for a full recovery. Many people have heard that a bad sprain can be as bad as a broken ankle and that can be true. Severe sprains are best served with a cast or boot for a few weeks followed by a medical grade brace for 1-2 months. Many patients need formal physical therapy to quickly return to 100%. Therapy also helps to regain your balance which can be lost when the ligaments are torn. Many injuries heal well enough to not hurt but people are not aware that their balance is gone until they find themselves with another sprain down the road.
There are also a number of other injuries that can occur with a sprain. If you notice that a mild sprain still hurts after a few weeks or you have a moderate sprain that doesn’t want to progress with treatment after 3-4 weeks in a boot and brace then often an MRI is needed to evaluate the extent of the soft tissue damage that an x-ray can’t pick up. There can be damage to the cartilage in the ankle joint itself, the tendons can be inflamed or torn, and other injuries can occur that may need a different treatment plan.
An ankle sprain can definitely be a bad injury but if treated appropriately they rarely cause long term issues. The vast majority of sprains return to normal function and never result in chronic pain or instability. There are many home treatments for minor sprains and when in doubt it is never a bad idea to get some help from a professional. Never live life in pain. If an ankle sprain is slowing you down come see us at New Mexico Foot and Ankle Institute and we’ll work on a plan to get you back to normal activity as quickly as possible.