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Sprained ankle - Symptoms and treatment

This factsheet is for people who have a sprained ankle, or who would like information about ankle sprains.

A sprain is an injury to a ligament. Ligaments are strong bands of tissue that connect one bone to another and so help to hold joints together.

What is a sprained ankle?

A sprained ankle is the most common type of soft tissue injury. Soft tissue means any tissue in your body that isn't bone. Each year, around six out of every 1,000 people in England go to their GP or hospital accident and emergency department with a sprained ankle.

A minor sprain is when a ligament is stretched or partially torn. In severe sprains the ligament is completely torn. Sometimes the end of the bone to which a ligament is attached can crack.

Symptoms of a sprained ankle

When you sprain your ankle there is sometimes a snapping or popping sound and a feeling of "giving way" as a ligament is torn or bone cracked. A sprain can be very painful, with the pain getting worse when you move your ankle. With a severe sprain, you may not be able to bear weight on your leg.

You may have swelling and bruising. Swelling happens soon after the injury but bruising can take up to 24 hours to fully develop. The swelling around your ankle can make it difficult to move your foot, and your ankle may feel unstable.

You should see a doctor if:

  • your ankle remains extremely painful or swollen after about two to four weeks.
  • you have a lot of pain, redness or swelling over a bony area of your foot
  • you can't bear any weight on the affected leg
  • there is any obvious change in the shape of your ankle

Causes of a sprained ankle

The most common type of ankle sprain is when your foot turns inwards, overstretching the ligaments on the outside of your ankle. This is called an inversion sprain.

Half of all ankle sprains happen during sport. They are especially common in sports that involve running and jumping, landing from a jump, fast changes in direction or lots of stop-starts (such as football, basketball and volleyball).

Other common causes of ankle sprains include:

  • walking on an irregular surface
  • your foot slipping off the edge of a kerb
  • twisting your ankle while climbing stairs
  • losing your balance wearing high-heels

You are more likely to sprain your ankle if it has happened before.

Diagnosis of a sprained ankle

You may not need to see your GP or visit the accident and emergency department at a hospital. It depends on how severe your symptoms are.

If you do seek medical treatment, your doctor will examine your ankle to assess how bad the sprain is. He or she will ask about your symptoms and how the injury happened, which will help establish which ligaments are involved. You will also be asked to try and walk.

Your doctor may recommend an X-ray if he or she suspects that a bone has been damaged and needs specific treatment.

Treatment of a sprained ankle

Treatment depends on how serious the injury is.

Early treatment

All soft tissue injuries should receive the same immediate first aid treatment. Treatment follows the RICE procedure, which stands for the following.

  • Rest the injury initially, then re-introduce movement so you don't lose too much muscle strength.
  • Ice packs or a bag of frozen peas wrapped in a towel should be applied to your ankle to reduce swelling and bruising. You could also immerse your ankle in ice. You should not apply ice directly to your skin as it can give you an "ice burn" - place a cloth between the ice and skin.
  • Compress your ankle by bandaging it to support the injury and help decrease swelling.
  • Elevate your ankle by resting your foot above the level of your heart and keep it supported.

Further treatment will vary according to how badly you have sprained your ankle.

Applying heat - eg warm baths or a hot water bottle - may be soothing. They encourage blood flow, the opposite effect of ice, so these treatments should not be used during the first two days while swelling is developing.

Your GP may refer you to a physiotherapist who can advise you on exercises and may use massage, heat, ultrasound or other treatments. A sports medicine specialist may help you if you play professional or competitive sports.

Medicines

Over-the-counter painkillers can help reduce pain. Some may help reduce swelling. Painkilling creams or gels don't work any better than tablets. Ask your pharmacist for advice and always read the patient information leaflet that comes with the medicine.

Surgery

Surgery can repair torn ankle ligaments, but there isn't enough evidence to say whether this is better than keeping you ankle in a cast, or wearing a support brace. Your doctor may recommend surgery for torn ankle ligaments that aren't getting better.

Recovering from a sprained ankle

The swelling and discomfort should begin to subside after a few days. At this point, you should begin to move your ankle. Compression bandages should normally be taken off after two days because they limit movement. Instead you can use a support or taping that doesn't restrict movement too much.

Initial exercises can include rotating the foot and moving it up and down. Take care not to cause more pain while you are moving your foot. Try to increase the range of movement each day.

Prevention

A brace or taping that supports your ankle, but still allows you to move it, may help prevent you spraining your ankle again.

Warming up and stretching well when you are taking part in sports may reduce the risk of sprains. Aim for a steady build up to exercise rather than occasional bouts of vigorous sport. Try to do some strength and endurance training before the season begins if you are a competitive sports person.

Further information

Sources

  • Sprains and strains. NHS Library for Health. Clinical Knowledge Summaries
    http://cks.library.nhs.uk
    accessed 6 March 2007
  • Ankle sprain. BMJ Clinical Evidence
    www.clinicalevidence.co.uk
    accessed 6 March 2007
  • Kerkhoffs G, Struijs P, Marti R et al. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews, 2002. Issue 3, Art. No: CD002938
  • Kerkhoffs G, Handoll H, de Bie R, Rowe B & Struijs P. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3, Art. No: CD000380.pub2

This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett Bsc MBChB MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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For more information about discounted BUPA private medical insurance for members of approved fitness centres, please call BUPA today on 0800 600 500 and quote A711.

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