Ankle sprain: symptoms, treatment and how long recovery takes

Most sprains are mild injuries that can be treated at home without surgery. The NHS says that for the first 2 to 3 days you can follow the five steps known as PRICE therapy to help bring down swelling and support the injury.

• Protection: protect the injury, for example with a support or shoes that support your foot or ankle.

• Rest: stop exercise and activities and try not to put weight on the injury.

• Ice: apply an ice pack, or a bag of frozen vegetables wrapped in a tea towel, for up to 20 minutes every 2 to 3 hours.

• Compression: wrap a bandage around the injury to support it during the day.

• Elevation: keep it raised on a pillow as much as possible.

The NHS says to avoid heat (such as hot baths and heat packs), alcohol and massage for the first couple of days, as these can increase swelling. A pharmacist can suggest the best treatment. At first, try painkillers like paracetamol to ease pain and ibuprofen gel, mousse or spray to bring down swelling, and if needed ibuprofen tablets, capsules or syrup.

When you can move the injured area without pain stopping you, the NHS says to keep moving it so the joint does not become stiff. Milton Keynes University Hospital says to weight-bear as tolerated and gradually return to activities as symptoms allow, to avoid forceful activities such as running or jumping until you can walk without pain, and that an elasticated bandage is usually not needed after 2 to 3 weeks.

For more severe injuries with ongoing instability, the same leaflet says treatment consists of protected weight bearing in a cast or protective brace for 1 to 3 weeks, followed by physiotherapy and graded return to function.

The NHS says it is likely to be a sprain if you have pain, tenderness or weakness around the ankle, the injured area is swollen or bruised, you cannot put weight on it or use it normally, or you have muscle spasms or cramping.

Milton Keynes University Hospital says that after the injury you may hear a pop, and pain and swelling invariably result. Bruising becomes obvious over the first few days, and it can be painful or difficult to walk. It describes sprains as categorised into mild, moderate and severe depending on the amount of damage to the ligaments.

The NHS says that after 2 weeks most sprains and strains will feel better, that you should avoid strenuous exercise such as running for up to 8 weeks because of the risk of further damage, and that severe sprains can take months to get back to normal.

Milton Keynes University Hospital describes three phases of recovery. Phase 1 is resting, protecting the ankle and reducing swelling. Phase 2 is restoring range of movement, strength and flexibility. Phase 3 is a gradual return to activities, avoiding sharp turns or twists at first, followed by a return to all activities as symptoms allow. In most ankle sprains this takes 4 to 6 weeks, but the more severe the injury, the longer it takes, and return to sport and manual work should be expected to take the full 4 to 6 weeks.

Milton Keynes University Hospital says that once the initial pain and swelling begin to settle and you can tolerate weight-bearing, you should start ankle stretches to regain range of movement, performed twice a day. It describes the following.

• Seated with your leg hanging down: bring the ankle and foot up as far as you can, hold for 5 seconds, then point your foot away and hold for 5 seconds. Repeat 10 times.

• Keeping your knee still, turn the sole of the foot inwards (inversion), hold for 5 seconds and repeat 10 times, then turn it up and out (eversion), hold for 5 seconds and repeat 10 times.

• Seated with your feet flat on the floor: raise the front of your feet with heels down, hold for 5 seconds, then raise your heels with the balls of your feet down, hold for 5 seconds. Repeat 10 times.

A sprain and a break can feel similar. The NHS says to get help from NHS 111 if you have had an injury and it is very painful or the pain is getting worse, there is a large amount of swelling or bruising, you cannot put any weight on it or walk more than a few steps, it feels very stiff or is difficult to move, it is not feeling any better after treating it yourself, or you also have a very high temperature or feel hot, cold or shivery.

The NHS says to call 999 or go to A&E if you heard a crack when you had your injury, the injured body part has changed shape or is pointing at an odd angle, it is numb, tingling or has pins and needles, or the skin around the injury has changed colour such as looking blue or grey, or is cold to touch. You may have broken a bone and will need an X-ray.

The NHS broken ankle page adds that you should get an ankle checked by a doctor if you are not sure whether it is broken, and that a broken ankle usually takes 6 to 8 weeks to heal, but can take longer.

Milton Keynes University Hospital says rarely people with ankle sprains can develop long-term instability problems. If pain does not settle within 6 weeks, or you develop symptoms of giving way or ankle instability, further clinical review is needed. Symptoms can be due to damage to the cartilage of the ankle joint or failure of the ligaments to heal.

In that situation the leaflet says the surgeon may recommend an MRI scan to see whether surgery such as ligament reconstruction or ankle arthroscopy is indicated, and that your doctor may recommend further investigations such as an ultrasound scan or MRI if symptoms are not improving as expected. It says surgery is rarely needed.

Most sprains can be managed with self-care and pharmacy advice. The NHS says that in many areas you may be able to get help, such as physiotherapy, from NHS community musculoskeletal (MSK) services without needing a referral from a GP, and that you may be given self-care advice or a stronger painkiller, or need an X-ray.

The NHS says physiotherapy from the NHS might not be available everywhere and waiting times can be long, and that you can also get physiotherapy privately from a chartered physiotherapist. If you use a private clinic, make sure any scan results or advice are shared with your GP.