An ankle sprain is a stretch or tear of the ligaments on the outside of the ankle, usually from rolling the foot inwards. Most heal well in 2–12 weeks, but around a third of people who don't do balance and strength exercises sprain the same ankle again within a year – and repeat sprains can leave the ankle chronically unstable.
This guide from the foot and ankle team at Sports Orthopedics Institute, Bengaluru explains sprain grades, when you need an X-ray, what treatment actually works, and how to stop it happening again.
Key takeaways
- You may not need an X-ray – the Ottawa ankle rules reliably identify who does.
- Protect, then move: a short period of protection, then early walking and exercise works better than long rest.
- For severe sprains, a short period in a below-knee cast or brace speeds recovery compared with a simple bandage.
- Balance training cuts repeat sprains by about a third.
- Surgery is rarely needed – mainly for ankles that keep giving way despite good rehabilitation.
Causes, Symptoms and Grades
How it happens
Most sprains happen when the foot rolls inwards, stretching the ligaments on the outer side of the ankle. Common situations include:
- Landing awkwardly in basketball, volleyball, football, badminton or cricket
- Uneven ground – a pothole, kerb, rocky path or stairs
- Changing direction quickly on a slippery or uneven surface
- A previous sprain – the biggest risk factor for another one
Symptoms
- Pain and swelling on the outer side of the ankle
- Bruising, sometimes spreading to the foot
- Difficulty walking
- A feeling that the ankle is weak or unstable
Grades of sprain
|
Grade |
Ligament damage |
What you notice |
Typical recovery |
|---|---|---|---|
|
1 – Mild |
Stretched, with tiny tears |
Mild pain and swelling; can walk |
About 1–3 weeks |
|
2 – Moderate |
Partly torn |
Moderate swelling and bruising; walking painful |
About 3–6 weeks |
|
3 – Severe |
Completely torn |
Marked swelling and bruising; often can't bear weight; ankle may feel unstable |
About 6–12 weeks or more |
Sprain or Fracture? When You Need an X-ray
Fewer than 15% of people who have an X-ray after an ankle injury actually have a fracture. (BMJ, 2003) The Ottawa ankle rules help doctors decide who needs one.
An ankle X-ray is needed if there is pain around the ankle bones and any of:
- Bone tenderness at the back edge or tip of either ankle bone (the lower 6 cm)
- Inability to take four steps both straight after the injury and when examined
A foot X-ray is needed if there is pain in the midfoot and tenderness at the base of the fifth metatarsal (outer edge of the foot) or the navicular (inner midfoot), or inability to take four steps.
How reliable are they? A meta-analysis of 66 studies found the rules picked up about 99% of fractures, so a negative result reliably rules out a significant fracture (Br J Sports Med, 2017).
When a sprain is something more
See a specialist if pain is high up between the shin bones (a “high ankle sprain”), if there is pain deep in the joint weeks later (possible cartilage injury), or if the ankle keeps giving way.
Treatment
The first few days: from RICE to PEACE & LOVE
Rest, ice, compression and elevation (RICE) is still widely recommended, but newer guidance from sports medicine experts – summarised as PEACE & LOVE (Dubois & Esculier, British Journal of Sports Medicine, 2020) – places more emphasis on early movement and on avoiding long rest.
First 1–3 days (PEACE):
- Protect – limit painful activities for a few days
- Elevate – raise the ankle above heart level when resting
- Avoid anti-inflammatories in the first days, as they may slow tissue healing
- Compress – use a bandage or brace to limit swelling
- Educate – understand that active recovery works better than passive treatments
After the first days (LOVE):
- Load – start walking and using the ankle as pain allows
- Optimism – confidence helps recovery
- Vascularisation – pain-free cardio such as cycling
- Exercise – balance, strength and movement exercises
Ice can still be used for pain relief, but it isn't needed to help healing.
Support for severe sprains
In a UK trial of 584 people with severe sprains, a 10-day below-knee cast gave faster recovery at 3 months than a simple tubular bandage, with better function, pain and activity; an Aircast-type brace also improved function. The tubular bandage was the least effective option (Lancet, 2009). By 9 months, results were similar.
For mild and moderate sprains, a lace-up or stirrup brace for a few weeks helps you walk sooner and more confidently.
Rehabilitation and Recovery Time
|
Stage |
Typical timing |
Exercises |
|---|---|---|
|
Early movement |
Days 2–7 |
Ankle circles and alphabet tracing; gentle walking with a brace if needed |
|
Strength |
Weeks 1–3 |
Resistance band movements in all directions; calf raises on both feet, then one |
|
Balance |
Weeks 2–6 |
Single-leg standing, then eyes closed, then on a cushion or wobble board |
|
Return to sport |
Weeks 3–12, depending on grade |
Jogging, figure-of-eight running, hopping and cutting drills; sport-specific practice |
Ready to return to sport when: you can hop and land on the injured leg without pain, run and change direction confidently, and your balance matches the other side. Many athletes wear a brace or tape for the rest of the season.
Keep doing balance exercises for at least two months after you feel better – this is what prevents the next sprain.
Long-Term Problems and When Surgery Is Needed
Ankle sprains are often seen as minor, but they can cause lasting problems if not rehabilitated properly. In the year after a sprain, athletes have about twice the risk of spraining the same ankle again, and up to half of repeat sprains lead to chronic pain or instability (Hupperets et al., BMJ 2009).
Why does my ankle still hurt weeks later?
- Incomplete rehabilitation – weakness and poor balance
- Chronic ankle instability – the ankle keeps rolling or feels unreliable
- A missed injury – cartilage damage in the joint, a high ankle sprain, a small fracture, or a peroneal tendon tear
- Impingement – scar tissue pinching at the front of the ankle
If pain, swelling or giving way persists beyond 6–8 weeks, see a specialist. An MRI may be needed.
When is surgery needed?
Surgery is not needed for most sprains, even severe ones. It is considered when:
- The ankle keeps giving way despite a good course of balance and strength rehabilitation (usually at least 3 months)
- There is an associated injury that needs fixing, such as a cartilage lesion, a high ankle sprain with an unstable joint, or a tendon tear
The usual operation tightens or repairs the outer ankle ligaments (a Broström repair), often combined with ankle arthroscopy.
Prevention
The best protection against a repeat sprain is balance training. In a Dutch trial of 522 athletes, an unsupervised 8-week home balance programme (three 30-minute sessions a week) reduced repeat sprains over a year from 33% to 22% – a 35% reduction. One repeat sprain was prevented for every nine athletes who did the programme (BMJ, 2009).
- Balance exercises – single-leg standing, wobble board, hopping and landing drills
- Strength work – calf raises and resistance band exercises
- A brace or tape for sport in the year after a sprain
- Warm up properly before sport
- Supportive footwear suited to your sport, and care on uneven ground
How Sports Orthopedics Institute Can Help
Our foot and ankle team in HSR Layout, Bengaluru offers prompt assessment, structured rehabilitation, and treatment for ankles that keep giving way, including ankle arthroscopy and ligament repair. We also see other causes of foot and ankle pain, such as plantar fasciitis and stress fractures.
Book at sportsorthopedics.in or call +91 6364538660 / +91 9008520831.
Frequently Asked Questions
How long does it take to recover from an ankle sprain?
About 1–3 weeks for a mild sprain, 3–6 weeks for a moderate one, and 6–12 weeks or more for a severe one. Ligaments keep strengthening for several months, so keep up your exercises.
Can ankle sprains cause long-term problems?
Yes. Repeat sprains are common, and up to half lead to chronic pain or instability. Balance and strength training greatly reduces this risk.
What's the difference between a sprain and a fracture?
A sprain injures the ligaments; a fracture breaks a bone. Both can cause pain and swelling. If you can't take four steps or there is tenderness over specific bony points, an X-ray is needed.
How do I prevent ankle sprains?
Do balance and strength exercises, especially after a previous sprain; wear a brace or tape for sport in the following year; and warm up before activity.
Is surgery always necessary for severe ankle sprains?
No. Even complete ligament tears usually heal well with a short period of protection and good rehabilitation. Surgery is for ankles that keep giving way despite rehab, or for associated injuries.
Why does my ankle still hurt weeks after a sprain?
Common reasons are incomplete rehabilitation, ongoing instability, or a missed injury such as cartilage damage or a high ankle sprain. If symptoms last beyond 6–8 weeks, see a specialist.
Should I use ice?
Ice can ease pain in the first days, but current guidance places more emphasis on early, gentle movement than on ice.
References
- Bachmann LM, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ, 2003;326:417–419.
- Beckenkamp PR, et al. Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis. Br J Sports Med, 2017;51(6):504–510.
- Lamb SE, et al. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet, 2009;373:575–581.
- Hupperets MDW, et al. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 2009;339:b2684.
- Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med, 2020.
Disclaimer: This article is for general information and does not replace advice from a qualified healthcare professional.