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Ankle Sprains: Recognition and Treatment

Primary care physican can treat most instead of ER

Ankle sprains are the most common injury in high school sports, with high rates of recurrent injury and loss of participation from sport (1,2) 

What is a sprain?

A sprain is a stretch and/or tear of a ligament, the fibrous band of tissue joining the end of one bone with another that stabilizes and supports the body's joints.

Because the outer ankle is more stable than the inner ankle, the foot is likely to turn inward (ankle inversion) from a fall, tackle, or jump. This stretches or tears ligaments; the result is an ankle sprain. The lateral ligament on the outer ankle is most prone to injury. As a result, virtually all ankle sprains are "inversion" sprains.

Symptoms and treatment of ankle sprains

As with burns, there are three "degrees" of sprains: mild (first-degree), moderate (second degree) and severe (third-degree). While the intensity varies, pain, bruising, and swelling (inflammation) are common to all three categories. 


First Degree (Mild)

Second Degree (Moderate)

Third Degree (Severe)


Minor stretching of ligaments

Partial tear of ligaments

Complete tear of ligaments, or ligaments separate from bone


Not necessary unless suspect a fracture

Note: Studies show that x-rays are ordered for 80% to 90% of patients who go to the ER after a foot or ankle injury, yet only 15% actually have fractures. (2)

Sometimes, depending on exam. 

Sometimes, depending on exam

Emergency room or doctor's office visit

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day


Minimal; may not be swelling for several hours



Ankle Instability?


Yes (mild)

Yes (unable to bear any weight)

Painful to stand and walk?



Yes. Excruciating pain at moment of injury


RICE, non-steroidal anti-inflammatory drugs (NSAIDS), functional rehabilitation (ankle stabilization via elastic bandage, braing, taping or external support or combination), progressive weight bearing and exercise.

RICE, NSAIDS, functional rehabilitation plus crutches (rent at medical supply store)  until can bear weight well (recovery time varies from a few days to a week);

RICE, NSAIDS, functional rehabilitation; cast and crutches, although no consensus on the best type and duration of immobilization (2); surgery may be necessary

From 2 days up to a week

Usually 2 to 3 weeks (after physical therapy), but possibly as long as 6 weeks

Recovery after intensive physical therapy may take 6 to 8 weeks



1. Swenson D, Collins C, Fields S, Comstock D. Epidemiology of US High School Sports-Related Ligamentous Ankle Injuries, 2005/06 - 20010/11. Clin J Sport Med 2013;23(3):190-196.


2. Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins TJ, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Tr 2013;48(4):528-545.

Updated April 12, 2015

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