Ankle sprains are soft tissue injuries which are usually accompanied by pain, tenderness, swelling, bruising and some restriction in movement. The first 24 hours after the injury are important and the following advice will help minimise complications and promote healing. We can remind ourselves of what to do using the acronym PRICE which stands for Protection, Rest, Ice, Compression and Elevation.
During the first 24 hours the foot or ankle should be protected from undue stress which may cause further damage or delay healing. This means stopping activities which increase your symptoms.
This does not mean lie down and wait until the problem goes away, but to restrict activity as much as possible. This may mean using crutches. Any unaffected parts of your leg may still be exercised.
Applying ice or cold water to the injured area helps reduce bruising. Application of ice can be repeated regularly – every 2 hours in the first 24 hours, but it must be done carefully, as it is possible to get an ice burn.
Technique for the application of ice treatment at home:
- Use either a bag of frozen peas or a polythene bag with ice cubes.
- Cover the area to be treated with a damp tea towel or damp cloth.
- Place the ice pack over the area and hold in position with a towel or bandage.
- Leave for 10 to 15 minutes on bony areas or 20-25 minutes over more fleshy or muscular areas.
- Check the skin every 5 minutes and if it becomes white, blue or blotchy or painful, numb or tingles, remove the ice pack.
Putting a firm bandage around the part will help to contain any swelling. In the hours after injury swelling may continue to increase, so check the bandage is not too tight or uncomfortable. Make sure you can still feel your toes and that the bandage is removed at night. Reduce its use as any swelling goes down.
Wherever possible, support the injured leg in a raised position a little above your hip is best for your foot. This will help the blood flow and reduce the swelling in the injured area.
After 48 hours, if the pain is easing the treatment changes slightly. We move from PRICE to MICE – removing Protection and replacing it with Movement.
It is normal to experience some discomfort when you begin moving your ankle but you should attempt the exercises below regularly and start to walk as normally as possible within your pain limits. You may still require crutches or a walking stick.
Ice, Compression and Elevation
Should continue as above.
Exercises (try to perform 8- exercises each hour)
- Sitting or lying circle your ankle and foot in one direction. Hold for 5 seconds. Repeat in the opposite direction.
- Sitting or lying move your foot up and down at the ankle. Try to move as far as you feel comfortable. Hold for 5 seconds.
- Sitting with your foot on the floor. Turn the sole of the foot inwards. Hold for 5 seconds. Turn outwards. Hold for 5 seconds. Put your foot flat on the floor and start to put some weight through the injured foot by pushing down through your heel and toes. Progress the exercise in standing, as pain allows, by trying to balance on the affected side.
It is important to AVOID limping and walk as normally as possible. Try to put your heel down first and push off through your toes. If using a stick or crutch, hold it in the opposite hand to the affected side. Take shorter steps and begin with trying short distances and increase walking as pain allows.
Getting Back to Normal
Injuries heal at different rates, but you should expect a gradual improvement from 48 hours onwards after injury and be able to bear your weight. Ankle sprains can take 4 to 6 weeks for pain and stiffness to settle and some symptoms can remain for 10 to 12 weeks depending on the severity of the ankle injury. If you continue to experience problems and have not been referred to physiotherapy then you should consult your GP.
Reproduced with the kind permission of NHS Fife Physiotherapy services.