Ankle sprains occur when ligaments that connect the bones in the foot, ankle, and lower leg stretch or tear.
People usually feel immediate pain at the site of an ankle sprain. Often the ankle starts to swell immediately and may develop bruising. The affected area is usually tender to touch and may feel “wobbly” or unstable.
In a mild sprain, swelling usually goes down within a few days.
The severity of your symptoms usually depends on how much tearing has occurred. In more severe sprains, you are often not able to walk or even put weight on your foot, and your ankle may feel unstable. You usually have extreme pain at first, but some people start to feel better fairly soon. You might hear and/or feel a tearing sensation and a pop or a snap.
If a sprain does not heal correctly, your ankle joint may be more susceptible to injury again, or the pain may not go away. This often occurs with even a slight trauma, such as stepping off a curb or walking on uneven pavement. Some people complain of persistent pain and swelling.
There are different types of ankle sprains.
An inversion injury, the most common cause of ankle sprains, occurs when the ankle rolls outward and the foot turns inward. It results in stretching and tearing of the ligaments on the outside of the ankle.
In an eversion injury, the ankle rolls inward and the foot turns outward, damaging the ligaments at the inside of the ankle.
In a “high” ankle sprain, a less common type of injury, ligaments that join the two lower leg bones together above the ankle, called the syndesmosis, are injured. This usually happens if the foot is forced up, or if the leg is forcefully twisted while the foot is planted. Damage to the ligament varies from simply stretched or slightly torn to completely torn. Your doctor will grade your sprain accordingly.
Initial treatment for an ankle sprain is summarized as the RICE approach: Rest, ice, compression and elevation.
If you are not taking any prescription pain relievers, you may want to take an over-the-counter drug such as ibuprofen or naproxen to reduce pain and swelling. Surgery to repair torn ligaments is usually only considered when there is a severe ligament tear (or tears) or if the ankle remains unstable after rehab. Surgery is also a consideration if you have a broken bone.