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What to do For a Sprained Ankle

It is sometimes called a “twisted” or “turned” ankle, but the term ankle “sprain” is preferred because it implies that an injury has occurred. The injury is to ligaments and tendons which support the stability of the ankle. There are degrees of injury, and certainly some can be so mild as to not interrupt play or require medical evaluation. Other injuries can be so severe that they completely disrupt ligaments or tendons, in which case surgical intervention is sometimes required.

Acute care of the sprained ankle…

  • Rest–not strict bed rest, but a decrease in your usual level of activity.
  • Ice – Ice is the fastest available pain relief and limits swelling. Usually twenty minute intervals on then off for a few hours is adequate. It probably has little value after the first 24 hours. Although there are proponents ice, heat, or both after the 24 hour period to speed healing.
  • Ibuprofen – 10 milligrams per kilogram every 6 hours as needed. For older adolescents weighing more than 40 kilograms (88 lbs) 400 milligrams is appropriate. Usually two days of therapy is adequate. Concern that the anti-inflammatory properties of ibuprofen will inhibit healing over this short period is unwarranted.
  • Elevation- The importance of elevation is often overlooked, but it is an easy, effective way to reduce swelling and the pain due to swelling.
  • Compression wrap- Frequently called an “Ace” wrap (one available brand), the wrap serves to hold ice bags in place and limit swelling. Pain and numbness will occur if the wrap is too tight.

When does a sprained ankle need to be seen by the doctor?
If there is significant swelling, bruising, or difficulty bearing weight, then evaluation is warranted. Additionally, if the discomfort is more above the ankle than below, or if the injury is an “eversion” injury (if the injury occurred by the sole of the ankle turning outward and the ankle turning inward), these injuries should also be evaluated. Finally, if pain persists at seven days then the ankle should be evaluated or re-evaluated if it has previously been checked.

Unless indicated by your child’s physician otherwise, the following is appropriate care for the sprained ankle after the initial phase.

  • Avoid returning to competitive sports too soon: It will take months before the ankle is “100%”. With the mildest ankle sprain, a minimum of one week is necessary. Training can be started when weight-bearing is pain-free. Competition may begin after one week of pain-free training. For more serious sprains, return to sports should be under the direction of your child’s doctor. Cardiovascular fitness can be maintained by non-impact exercises such as swimming or use of a stationary bicycle. Returning too soon can lead to re-injury and poor healing.
  • Tape the ankle during both training and competition for the rest of the season or about two months: Taping can provide support and limit the excess motion that occurs with stretched ligaments. See the figure below that demonstrates the taping technique.
  • Strengthening exercises: For the ankle, involve strengthening the gastrocnemius and peroneus muscle groups. Heel lifts are performed in three positions: feet parallel, toes apart, and toes together. These exercises are ideal for this purpose. Thirty repetitions twice a day is adequate.

Post-Acute Care – Read our article  on Sprains and Strains