Care of your ankle injury

What have I done to my ankle?

You have what is called a soft tissue injury—also known as a strain or sprain.

What is a sprain?

A sprain is an injury to a ligament. Ligaments are strong tissues around joints which attach bones together. They give support to joints. A ligament can be injured, usually by being stretched during a sudden pull. Ligaments around the ankle are the ones most commonly sprained. The severity of a sprain is graded into:

• Grade I—mild stretching of the ligament without joint instability
• Grade II—partial rupture (tear) of the ligament but without causing joint instability
• Grade III—complete rupture (tear) of the ligament with instability of the joint

A damaged ligament causes inflammation, swelling and bleeding (bruising) around the affected joint. Movement of the ankle joint is painful when you have a sprained ankle.

Have I broken anything?

No, you haven’t broken any bones in your ankle. The doctor or Nurse Practitioner may or may not have requested an X-ray. If not, do not worry. It is not always necessary.

What is the aim of treatment?

Usually, the damaged ligament heals itself over time. Some scar tissue may be produced where there has been tearing of tissues. The main aims of treatment are to keep inflammation, swelling, and pain to a minimum, and be able to use the ankle joint normally again as quickly as possible.

What is the treatment of a sprain?

For the first 48–72 hours think of:

• Paying the PRICE—Protect, Rest, Ice , Compression, Elevation
• Do no HARM—no Heat , Alcohol, Running or Massage

Paying the PRICE

• Protect the injured ankle from further injury. For example, a bandage and/or ankle support may help with this.
• Rest the ankle joint for 48–72 hours following injury.
• Ice should be applied as soon as possible after the injury for 10–30 minutes. Less than 10 minutes may have little effect. More than 30 minutes may cause damage to the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel (do not put ice directly onto skin as it may cause an ice burn). A bag of frozen peas is an alternative. Gently press the ice pack onto the injured part. The cold from the ice is thought to reduce blood flow to the damaged ligament. This may limit pain and inflammation. After the first application, some doctors recommend reapplying ice for 15 minutes every 2 hours (during the day) for the first 48–72 hours. Do not leave ice on while asleep.
• Compression with a bandage will limit swelling and help to rest the joint. A tubular compression bandage is often used but should be removed at night by easing it off gradually. Put on again before you get out of bed in the morning. Mild pressure that is not too uncomfortable or too tight, and does not stop blood flow, is ideal. Depending on the amount of swelling you may be advised to remove the bandage for good after 48 hours. This is because the bandage may limit movement of the joint which should normally be moving more freely after this time. However, bandages are sometimes kept on for longer to help keep swelling down and to keep the joint more comfortable.
• Elevation aims to limit and reduce swelling. For example, keep the foot up on a chair to at least hip level when you are sitting. It may be easier to lie on a sofa and to put your foot on some cushions. When you are in bed, put your foot on a pillow.

Do no HARM for 72 hours after injury

• Heat—hot baths, saunas, heat packs etc—has the opposite effect on the blood flow to ice. That is, it encourages blood flow. Heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat can be soothing.
• Alcohol can increase bleeding and swelling and decrease healing.
• Running may cause further damage.
• Massage may increase bleeding and swelling. However, as with heat, after about 72 hours gentle massage may be soothing.

Should I take painkillers?

Unless we have prescribed something, try whichever painkillers you would normally take for a headache. If you follow the advice given in this leaflet, the pain should begin to ease but it may take a while. You may not be walking normally on your ankle for a couple of weeks—especially if the pain is severe.

Should I exercise my ankle?

After the first couple of days of elevating and resting your ankle, you may begin to exercise it—this may be painful at first. These gentle exercises will help to reduce the swelling and prevent stiffness. Try to do 5–10 of these every hour:

• Point your toes and feet, and then bring them back towards you
• Keeping your heel still, move your foot from left to right (keeping your hip and knee still)
• Circle your foot clockwise and anti-clockwise

The exercises may hurt at first but you should start to do them after the first couple of days. However, if the pain is too severe you should stop and try again later, or leave it until the next day.

As soon as you are able, you should try to walk properly wearing good supporting shoes, not high heels or sandals. You should only attempt to drive when you can move your ankle fully without pain.

Avoid any strenuous walking, running or any sport which will put a strain on your ankle until you can do all of the exercises in this leaflet without pain. It may take 4–6 weeks to return to your normal level of physical or sporting activity.

Remember—it may take at least a couple of weeks for the pain to disappear. If there is no improvement within this time please contact either your GP or our department for further advice.