It is common to experience swelling and pain around the ankle after twisting it, and you might be unsure whether a visit to the doctor is necessary or if it will resolve on its own in a few days.
Doctor or Not?
Determining when to see a doctor is not a straightforward question. The injuries that can occur from twisting an ankle are diverse. You might have just slightly twisted your foot or sustained an injury to the ligaments or joint capsule. It could also be more serious and involve a fracture in the ankle area. Alternatively, there might be no structural injury, and you could continue walking as if nothing happened.
However, if the situation seems worse and you are unsure whether a doctor visit is needed, there are five tests from the Ottawa Ankle Rules that you can perform yourself. The Ottawa Ankle Rules, developed in Canada in 1992, are very reliable in indicating whether there are signs of a fracture and if an X-ray is necessary.
If you are unable to take four steps immediately after the trauma or experience increased tenderness at any of the following points (A-D), you should consult a doctor.
- A: The lowest 6 cm of the posterior edge of the fibula (lateral malleolus)
- B: The lowest 6 cm of the posterior edge of the tibia (medial malleolus)
- C: The base of the 5th metatarsal
- D: The navicular bone (Os Naviculare)
In addition to these signs, you should see a doctor if you experience severe pain, significant swelling, coldness or numbness in the foot, or are unable to bear weight on the leg.
If the Ottawa signs are negative, it is very likely that no fracture is present. However, after an ankle sprain, your tissues (tendons, ligaments, muscles) might be injured and need some time to heal. We would like to explain how you can actively and passively support the healing process.
We follow the recommendations from scientific studies, which agree that early functional rehabilitation is appropriate.
After the trauma, your foot will likely be painful, possibly red, warm, and swollen. You will also notice a loss of function; movements might not be as smooth as usual. You may struggle with rolling your foot while walking, or tensing your muscles might be painful or difficult. All these are signs that you are in the first phase of wound healing. This phase is crucial for the healing process and should be taken seriously even after a sprain trauma.
For this first phase, we have the following recommendations:
The goal for the first few days after the injury is to protect the tissue, reduce pain and swelling, and prevent re-spraining. If you have read our post on Peace and Love for tissue injuries, you will notice that we adhere to the steps of “Peace” in this initial phase after the injury.
- Elevate the foot higher than your heart. This helps the return of fluid that has accumulated in the tissue due to the injury. If the swelling is significant, wearing a compression sock can help reduce the swelling or any edema that might have developed.
- This doesn’t mean you need to stay in bed all day. Movement helps keep the metabolism and circulation active. Try to move your toes frequently (curling – spreading) and make small, pain-free movements with your foot. Walking short distances is allowed if it can be done without pain. Initially, wear a bandage to prevent re-spraining. Complete immobilization should only be used if the pain or swelling is too severe, and even then, it should be as brief as possible.
- Anti-inflammatory painkillers should be taken only if absolutely necessary due to pain. They can interfere with and delay the natural healing process, which is not desirable. Mild pain (2-3 on a scale of 0-10) is completely normal and expected in the acute phase.
Applying ice is a common measure after a sprain trauma. However, scientific studies show no or only minimal effect. Applying ice immediately after the trauma may possibly provide pain relief.
After about a week, the acute phase will be over, and active measures in the healing process will become more important. Pain and swelling should have decreased somewhat by then, and movement should improve.
Early functional rehabilitation in physiotherapy is crucial for your foot to regain strength and stability. It is important that you gradually bear weight on your foot so that the tissues can rebuild and adapt. Of course, don’t overdo it initially. Start slowly and increase “step by step.”
For the second phase after a sprain trauma, we have the following recommendations:
Scientific studies show that proprioceptive training after a sprain trauma significantly reduces the recurrence rate. The single-leg stand on a mat is a suitable starting exercise.
If this goes well – you can stand for 20-30 seconds without problems – you can practice on a less stable surface (balance board, air cushion).
Additional exercises we recommend in therapy:
Balance with a Towel Swipe
Side Steps
Side Lunges
Often, after a sprain trauma, the ankle shows a slight restriction in movement. Usually, lifting the foot or foot flexion is restricted. You can also do something about this:
In addition to proprioceptive training and exercises for increasing range of motion, the foot and hip/leg muscles should also be strengthened. Calf raises, squats, lunges, hip abduction, and clam shell exercises are suitable for this purpose.
Besides the exercises mentioned above, engaging in activities such as cycling, swimming, or Nordic walking is also beneficial. These endurance activities keep your metabolism going and ensure good circulation in the tissues.
It is important to mention that you should avoid pain during exercises/activities in this phase to ensure your tissue repairs optimally and does not get reinjured.
If you want to return to sports after a sprain trauma, you should specifically prepare for it and tailor the training to the specific demands of the sport.
In field sports such as soccer, handball, volleyball, basketball, or trail running, sprain traumas are particularly common. Here, it can be individually assessed whether a prophylactic bandage should be used.