Ankle Sprains: Why You Should Take Them More Seriously

Ankles have it hard — not only do they need to be sturdy enough to hold our bodies upright with ease, but they also need to be flexible enough to run, jump, squat, dance and do all sorts of activities. That's a lot of pressure to put on two small joints.

Hence, it's no surprise a sprained ankle is one of the most common musculoskeletal injuries, affecting an estimated 2 million people in the U.S. every year. All it takes is one awkward twist, turn or bend and — ouch! — you've sprained your ankle.

Fortunately, most sprains heal without any issues when treated properly. But for a variety of reasons, around 10 to 15 percent of people who sprain their ankle — even just once — will develop chronic ankle instability, according to Dr. Travis Hanson, a Houston Methodist foot and ankle surgeon. If not properly managed, this condition can lead to further complications, including repeated ankle sprains, arthritis and potentially corrective surgery.

We spoke with Dr. Hanson on the factors that can affect healing, the importance of properly treating ankle sprains — even mild ones — and tips on how to protect your ankles from future sprains, injuries and complications.

The different ways that you can sprain your ankle

There are actually several different ways you can sprain your ankle, according to Dr. Hanson. Sprains happen when ligaments — strong, fibrous tissues that help stabilize your joints and hold your bones together — are forced beyond their normal range of motion, causing them to either stretch or tear.

In your ankle, the three main spots where you can stretch or tear your ligaments are:

• Laterally (the outer ankle)
• Medially (the inner ankle)
• High or syndesmotic (the upper ankle)

Laterally

When you think of an ankle sprain, the most likely type to come to mind are lateral ankle sprains, which make up the vast majority of ankle sprain injuries, according to Dr. Hanson. They happen when your ankle rolls over your foot, which is why they're sometimes referred to as "rolled ankles."

As this happens, the ligaments on the "lateral" or outside part of the ankle either hyperextend, stretch or tear.

Medially

It's less common for someone to sprain their ankle medially, or on the inside part of their ankle, says Dr. Hanson. These types of sprains occur when a person's ankle collapses inward, consequently stretching or tearing those inner-ankle ligaments, also called the "medial" deltoid ligaments.

These types of ankle sprains tend to be more severe and take a bit longer to recover, says Dr. Hanson. Still, he adds, most of them recovery fully without the need for surgery.

High or syndesmotic

Another fairly common sprain is the high ankle sprain, or "syndesmotic" sprain. These typically happen during high-intensity athletic activities, like football, soccer, basketball or rugby, and require a very specific type of force wherein your leg externally rotates as the foot is planted on the ground. This often forced and awkward motion typically ends up injuring the ligaments that stabilize the two long bones in your leg, the tibia and fibula.

High ankle sprains typically take longer for people to recover from and in severe cases may require surgical intervention, says Dr. Hanson.

How long does a sprained ankle take to heal?

In addition to type, ankle sprains are also graded based on the severity of the sprain. The higher the grade, the more severe the injury and the longer it will take for the ligaments to heal.

Grade 1: 2 to 3 weeks

Grade 1 is the least severe type of ankle sprain. Typically, grade 1 sprains result from mild stretching of the ligaments or very small tears. While you might experience a little pain and tenderness, most people with grade 1 sprains can bear wait and don't experience instability in their ankle.

"Grade 1 ankle sprains are usually pretty well-healed within two to three weeks," says Dr. Hanson. "A lightweight over-the-counter ankle brace, home ankle-strengthening exercises and avoidance of certain activities for those two to three weeks are sufficient for most people."

Grade 2: 3 to 6 weeks

A grade 2 sprain typically involves a partial tear of at least one ligament. You'll definitely feel some pain when walking or bearing weight, and there might even be a little bruising. Loss of function and range of motion is typical, and treatment of these types of sprain may involve a bit more care than an OTC brace, according to Dr. Hanson.

"For higher grade ankle sprains, I typically put patients in a walking boot for two weeks to really allow things to settle down and immobilize the joints," he says. "After two weeks, we'll put them in a sturdy ankle brace and often initiate physical therapy."

Grade 3: 6 weeks or longer

Grade 3 is the most severe type of sprain and typically means the ligament is torn completely. With these, you may not even be able to walk or bear any weight on it. Still, Dr. Hanson says even the worst acute ankle sprains often do not require surgery.

"We rarely perform surgery for an acute ankle sprain, even very bad sprains in high-grade athletes because the vast majority of these, when treated properly initially, will heal up and return back to normal," he says. "There are always certain circumstances, but almost every acute ankle sprain is, at least initially, managed non-surgically."

What other factors can affect how well your ankle heals?

Beyond type and grade, there are a number of factors that could potentially affect how well a person's ankle sprain heals and ultimately their chances of developing chronic ankle instability, says Dr. Hanson. This condition occurs when the ligaments in the ankle for whatever reason never fully return to normal and remain loose and weak. Consequently, people with chronic ankle instability are more likely to sprain or injure their ankle again.

"Most ankle ligaments will heal, but sometimes they don't," Dr. Hanson says. "There may be certain factors that contribute to someone developing chronic ankle instability. Maybe they have bad soft tissues in general. Maybe they're a bit older. Maybe they take an immunosuppressive medication chronically like steroids, which might suppress a robust soft tissue healing. Maybe that have some low-grade ligamentous laxity [or very flexible and hypermobile joints] and maybe it's just bad luck."

You can also delay your healing by returning back to activities before you're ready, says Dr. Hanson.

"If patients try to just grin and bear through the pain and maintain certain activities like playing sports despite having an ankle sprain, they're putting all sorts of strains on those ligaments as they're trying to heal," he says. "That might predispose them to not healing."

How to treat a sprained ankle and when to see a provider

As Dr. Hanson mentions, treating ankle sprains looks different based on the grade and type. For less severe sprains — that is, it's not terribly swollen or bruised, and you can still walk on it (albeit with some pain) — Dr. Hanson says conservative treatment options like the RICE method can be worth trying at first.

RICE, which stands for rest, ice, compression and elevation, is a common first-aid treatment for soft-tissue injuries like sprains and strains. The goal of RICE is to reduce swelling and pain, promote healing and prevent further injury to the ligaments.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and aspirin can also help reduce swelling if you're able to take them, he adds.

(Related: Which OTC Painkiller is Right for Me?)

"After a day or two, if you feel like your symptoms are improving, and you're able to walk comfortably on your ankle, I think some home care for these very low-grade type of sprains is a reasonable thing," Dr. Hanson says. "If you're not feeling better after a day or two, though, I think it makes sense then to get it checked out by a health care provider."

What happens if you develop chronic ankle instability?

"If you develop chronic ankle instability and are rolling your ankle on a frequent basis, every time you do that, you put yourself at risk of tearing tendons or injuring the cartilage in the joint," says Dr. Hanson. "Even if it's a low-grade cartilage contusion, over time if you keep injuring the cartilage, then you will gradually develop some chronic changes to that joint, and that may lead to the development of arthritis in the joint."

Reasons that you might have surgery for an ankle sprain are if you develop chronic ankle instability, continue to sprain or roll your ankle and cannot return to full activities after having tried non-surgical prevention measures like wearing a brace and undergoing physical therapy, says Dr. Hanson.

This is why proper care and prevention of future ankle sprains are so important, says Dr. Hanson. You want to avoid these chronic instability "episodes" as he calls them because you're putting yourself at further risk of damage every time they occur.

How to prevent ankle sprains and protect your joints

Whether you've previously sprained your ankle and develop some level of instability or are simply looking to protect your joints from further injury, Dr. Hanson shares two key tips for ankle sprain prevention and protection.

1. Wear an ankle brace during vigorous activity

"For certain patients, it makes sense to wear an ankle brace, not 24-7, but rather when they subject themselves to circumstances where they might be prone to rolling their ankle," Dr. Hanson says. "Such scenarios might be hiking on uneven terrain, playing pickleball, playing basketball and even walking on uneven sidewalk."

By limiting your ankle's range of motion, a brace helps stabilize the joint, supports the ligaments and may help prevent you from rolling or twisting your ankle.

(Related: Playing Pickleball? Here Are 5 Tips for Avoiding Injuries)

2. Exercise and strengthen your ankle muscles

"A lot of people who develop chronic ankle instability end up having some low-grade balance issues that they don't even really notice until they get in front of a physical therapist, who may put them through certain tests like closing their eyes and try standing on one leg," he says. "They'll often find that they can balance on their uninjured leg but can't on their other."

The thing is, you can't actually strengthen your ligaments, according to Dr. Hanson, but you can strengthen the muscles around the ankle that also help to stabilize the joint. A few exercises that can strengthen your ankle muscles and improve balance include:

• Draw the alphabet: Sitting down with your legs in front of you, draw the alphabet with your toes.
• Plantar flexion: Sitting down with your legs in front of you, point your toes down and hold this position for a few seconds and repeat.
• Dorsiflexion: Sitting down with your legs in front of you, flex your foot and pull your toes toward your shin. Hold for a few seconds and repeat.
• Inversion and eversion: Sitting down with your legs in front of you, rotate your ankle inward and outward and repeat.
• Calf raises: From standing or sitting, rise up onto your toes, hold for a few second and repeat.
• Single-leg balance: With or without support, balance on one leg for a few seconds and repeat on the other side.
• Hops: Hop up and down, landing lightly on the balls of your feet.
• Toe curls: Sitting down with your legs in front, curl your toes under your foot, hold for a few seconds and repeat.

Using sequentially more robust resistance bands while performing these exercises will help to increase your strength around the ankle, adds Dr. Hanson.

(Related: What's Causing My Foot and Ankle Pain?)