An ankle sprain is one of the most common injuries: the ankle is forced out of position, stretching or tearing the ligaments that hold its bones together. Nearly all sprains are treated without surgery, but a fracture can be mistaken for a sprain, and a poorly healed sprain can leave the ankle unstable.
Some ankle injuries need care right away. Cleveland Clinic advises going to the emergency room for extreme pain, swelling that keeps getting worse, discoloration or numbness, and getting seen right away if you can’t put any weight on the ankle.
In the short video above, Southwest Foot & Ankle Center, the practice of podiatrist Dr. Reza Mobarak, introduces ankle sprains. The information below comes from the medical organizations listed under Sources.
What happens to the ligaments
Ligaments are strong bands of tissue that connect bones and keep a joint stable. OrthoInfo, from the American Academy of Orthopaedic Surgeons (AAOS), says about 90% of sprains happen when the foot rolls inward, injuring ligaments on the outside of the ankle. Rolling outward is less common and injures the deltoid ligament on the inside.
A high ankle sprain damages the ligaments just above the ankle that join the two lower leg bones. Cleveland Clinic says it usually takes six to eight weeks to heal, longer than a typical sprain.
A previous sprain is the biggest risk factor for a new one, according to American Family Physician (AFP), the journal of the American Academy of Family Physicians.
Grades and symptoms
Typical symptoms are pain (especially when standing on the foot), tenderness, swelling, bruising, stiffness and a feeling that the ankle is unstable. OrthoInfo and Cleveland Clinic describe three grades:
- Grade 1 (mild): the ligament is stretched, with tiny tears. You can usually walk, and the ankle feels stable.
- Grade 2 (moderate): the ligament is partly torn. Swelling is greater, walking hurts, and the ankle may feel a little unstable.
- Grade 3 (severe): the ligament is torn completely. Swelling is severe, walking may not be possible, and the ankle is clearly unstable.
A 2025 AFP review notes that a recheck 4 to 7 days after the injury grades a sprain more accurately.
Could it be a fracture?
A broken bone can look and feel like a sprain, and the two can happen together, according to the American College of Foot and Ankle Surgeons (ACFAS).
Doctors often use a checklist called the Ottawa ankle rules. As described in AFP, an X-ray is generally needed when there is pain around the ankle bones and either the back edge or tip of the bony bump on either side of the ankle is tender, or you couldn’t take four steps right after the injury and still can’t at the exam. Similar checks apply to the middle of the foot. If none of these signs is present, a fracture is very unlikely.
Some fractures are easy to miss at first, AFP notes. If a “sprain” isn’t improving as expected, ask about an X-ray or MRI.
When to see a doctor
MedlinePlus advises contacting your provider if:
- you can’t walk, or walking is very painful
- pain doesn’t ease with rest, ice and pain relievers
- the ankle isn’t better after 5 to 7 days
- the ankle stays weak or keeps giving way
- the ankle becomes more discolored, or you notice numbness, tingling or coldness
Home care
For the first few days, home care usually follows RICE:
- Rest: stay off the ankle; crutches can help if walking is hard.
- Ice: about 20 minutes at a time, wrapped in a thin towel, never directly on the skin.
- Compression: an elastic wrap, snug but not tight enough to cut off circulation.
- Elevation: prop the ankle above the level of your heart.
Over-the-counter pain relievers may help. MedlinePlus advises asking your provider first if you have heart, kidney or liver disease, high blood pressure or stomach ulcers.
Pain and swelling usually improve within 48 hours, MedlinePlus says, and then you can gradually put more weight on the foot. AFP reports that early weight-bearing leads to a quicker return to activity than long rest. More severe sprains may need a brace, a walking boot or a cast.
Rehab and getting back to sports
OrthoInfo describes three rehab phases:
- Protect the ankle while swelling goes down.
- Rebuild motion, strength and balance, for example by standing on the injured foot.
- Return to activity gradually, with straight-line running before cutting and pivoting.
According to OrthoInfo, recovery takes about two weeks for minor sprains and 6 to 12 weeks for severe ones. Returning to sports before the ligament heals adds risk, so ask your doctor when you’re ready.
Preventing repeat sprains
- Finish your rehab. MedlinePlus says strengthening exercises help prevent future sprains.
- Keep up balance training, which AFP reports lowers the risk of future ankle injuries in athletes.
- Consider a brace or tape for sports. AFP says both reduce sprain risk, and its 2025 review recommends a brace during sports for up to a year after a sprain.
- Warm up, wear supportive shoes for your sport and watch for uneven ground, OrthoInfo and the American Podiatric Medical Association (APMA) advise.
Chronic ankle instability
ACFAS describes chronic ankle instability as an ankle that keeps giving way, often with ongoing pain, swelling and a wobbly feeling. It usually follows a sprain that didn’t heal fully or wasn’t fully rehabilitated. OrthoInfo warns that repeated sprains can damage cartilage and bone and raise the risk of arthritis.
Treatment usually starts with physical therapy and bracing. If the ankle stays unstable, surgery to repair or reconstruct the ligaments may be recommended.
Questions to ask your doctor
- Is this a sprain, or could a bone be broken? Do I need an X-ray?
- What grade is my sprain? Could it be a high ankle sprain?
- Should I use a brace, boot or crutches, and for how long?
- Do I need physical therapy, and which exercises should I do at home?
- When can I return to sports, and should I wear a brace or tape?
- I’ve sprained this ankle before. Could I have chronic ankle instability?
Dr. Mobarak is a podiatrist and foot and ankle surgeon at Southwest Foot & Ankle Center in Lewisville, Texas. See Dr. Mobarak’s Best Docs Network profile for more about the practice.
Sources
- American Academy of Orthopaedic Surgeons, OrthoInfo. Sprained Ankle.
- American College of Foot and Ankle Surgeons, FootHealthFacts. Ankle Sprain.
- American College of Foot and Ankle Surgeons, FootHealthFacts. Chronic Ankle Instability.
- American Podiatric Medical Association. Sprains, Strains, and Fractures.
- Cleveland Clinic. Sprained Ankle.
- Cleveland Clinic. High Ankle Sprain.
- Cleveland Clinic. Sprains.
- MedlinePlus (U.S. National Library of Medicine). Ankle sprain - aftercare.
- American Family Physician (American Academy of Family Physicians). Update on Acute Ankle Sprains (2012).
- American Family Physician (American Academy of Family Physicians). Management of Acute Ankle Sprains: Common Questions and Answers (2025).
- American Family Physician (American Academy of Family Physicians). Foot Fractures Frequently Misdiagnosed as Ankle Sprains (2002).
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
