Sprained ankle

A sprained ankle, or '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 trauma.

Rule out an ankle fracture

If a sprain occurs, you must first assess whether there is a bone fracture. The 'Ottawa ankle rules' are a set of tests to assess this. If you cannot walk more than 4 steps, or there is pain at specific bony points, there is a chance of a fracture. If a fracture is suspected, go straight 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 several phases. In the first few days after onset, it is important to rest the ankle. This reduces pain and swelling. If pain allows, the ankle may be (partially) loaded. Taping is usually not advised in the first few days after onset because the ankle is still too swollen at this stage.

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).
• Consider walking with crutches, with partial weight bearing on the ankle (do not put your full weight on the ankle).
• Move the ankle within the pain limit (bend and extend the ankle without pain).

It is advisable to have the ankle examined by a physiotherapist or sports physiotherapist between days three and five. They can assess the extent of the damage and are also able at that time to provide a prognosis (estimate) of recovery. 

The physiotherapist provides information and advice on how the treatment will proceed. The ankle can then be taped to protect torn lateral ankle ligaments. It is recommended to have the tape replaced after one week.

Recovery after a sprained ankle

Walking fully weight-bearing is usually possible after one or two weeks. '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 sport. By a normal recovery process we mean that there are no other complaints or conditions of the ankle that delay recovery. Think, for example, of osteoarthritis, inflammation or pain that cannot be controlled.

Treatment of a sprained ankle

The physiotherapist draws up a treatment plan based on the so-called function score. With mild injury, it is often already possible to perform daily activities fully and painlessly within two weeks. No additional treatment is then needed. The advice is always to contact the physiotherapist again if (pain) complaints persist.

With more severe injury, it is advisable to have the physiotherapist guide the process. After five days, the ankle may be loaded more. The load is increased through exercises and training over the following twelve weeks.

For up to about three weeks, bruising caused by a haematoma may be present in the foot and ankle region. If the bruising is still present after this period, it 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 advisable to wear an ankle brace for sport. Research has shown that this is the best way to prevent the ankle from spraining repeatedly. 

It has also been shown that playing sport with an ankle brace does not make your ankle 'lazy'. It is therefore fine to wear an ankle brace for a long time or always during sporting activities after you have sprained the ankle.

Risks of an ankle sprain

The greatest risk after a sprained ankle is insufficient recovery. An ankle that does not recover properly can develop into chronic ankle instability, meaning the ankle remains a 'weak ankle' and sprains frequently. Frequent spraining can, in turn, lead to premature wear and tear of the ankle. With every sprain, the cartilage takes a heavy blow, which can lead to damage.

Another major risk is overlooking other ankle conditions. 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 pitch impossible.

Self-check for sprained ankles

Do the online self-check and get an initial indication of your ankle complaints. The self-check compares your ankle complaints with the most common ankle conditions.