Sprained ankle

A sprained ankle, also called 'rolling the ankle', is an acute ankle injury. In most cases, the ligaments on the outside of the ankle are damaged. In medical terms, a sprained ankle is also called an inversion injury.

Rule out an ankle fracture

If a sprain occurs, you must first assess whether there is a fracture. The ’Ottawa ankle rules’ are a set of tests to assess this. If you cannot take more than 4 steps, or you have pain on certain bony points, there is a chance of a fracture. If a fracture is suspected, you should go directly to the emergency department at the hospital for further examination.

Course after a sprained ankle

If nothing is broken, normal recovery after a sprained ankle goes through different phases. The first few days after onset it is important to rest the ankle. This reduces pain and swelling. If the pain allows, the ankle may be (partially) loaded. Taping is usually not recommended in the first few days after onset because the ankle is still too swollen in this period.

What can you do yourself after an ankle sprain?
In the first three days after onset there are several things you can do yourself:

• Rest by not walking too much and elevating the leg.
• Optionally cool the ankle (15-20 min, one to three times a day).
• Use crutches if needed, with partial weight-bearing on the ankle (do not put full weight on the ankle).
• Move the ankle within the pain limit (bend and extend the ankle without pain).

It is recommended to have the ankle examined by a physical therapist or sports physical therapist between day three and five. They can assess how much damage there is and are also able at that time to make a prognosis (estimate) of recovery. 

The physical therapist provides information and advice about what the treatment will look like. If necessary, the ankle can then be taped to protect torn outer ankle ligaments. It is recommended to have the tape replaced after one week.

Recovery after a sprained ankle

Fully weight-bearing walking is usually possible after one or two weeks. The ‘normal’ recovery leads to healing without residual symptoms within six to eight weeks. After this period, normal activities are fully possible without pain. Within 12 weeks it is possible to return to full sports. A normal recovery process means that there are no other complaints or conditions of the ankle that delay recovery. Think of osteoarthritis, inflammation, or pain that cannot be controlled.

Treatment for a sprained ankle

The physical therapist creates a treatment plan based on the so-called function score . With minor injury it is often already possible to perform daily activities fully without pain within two weeks. No additional treatment is then needed. The advice is always to contact the physical therapist again if (pain) symptoms persist.

With more severe injury it is wise to have the physical therapist guide the process. After five days the ankle may be loaded more. The load is increased by means of exercises and training during the following twelve weeks.

Up to about three weeks a blue discoloration as a result of a bruise may be present in the foot and ankle region. If the bruising is still present after this period, this may indicate delayed recovery.

After six weeks, in most cases you can start sport-specific training. This training depends on the sport level. After an ankle sprain it is recommended to henceforth play sports with an ankle brace. Research has shown that this is the best way to prevent the ankle from spraining more and more often. 

Moreover, it has also been shown that playing sports with an ankle brace does not make your ankle "lazy". So it is fine to wear an ankle brace for a long time or always during sports activities after you have sprained the ankle.

Risks of an ankle sprain

The biggest risk after a sprained ankle is insufficient recovery. An ankle that does not recover well can develop chronic ankle instability, which means the ankle remains ‘weak’ and sprains frequently. Repeated sprains can in turn lead to premature wear of the ankle. With each sprain, the cartilage takes a huge hit, which can lead to damage.

In addition, overlooking other ankle conditions poses a major risk. The presence of other ankle conditions can change treatment and rehabilitation time. With inadequate treatment this can cause persistent complaints and possibly make returning to the field impossible.

Self-check for sprained ankles

Do the online self-check and get a first indication of your ankle symptoms. With the self-check your ankle symptoms are compared with the most common conditions of the ankle.