Sprained ankle: what to do and how we help by video

A sprained ankle happens when your foot rolls the wrong way and the ligaments of the ankle (the bands that hold the bones together) stretch or tear. Sometimes you feel a "pop" when it happens.

Sprains are graded: in grade I the ligament is stretched with little tearing; in grade II it is partly torn and the ankle often needs to be immobilized; in grade III the ligament is fully torn and surgery is sometimes needed.

In Puerto Rico it is an everyday injury: a bad step on the cobblestones of Old San Juan, in the sand, on a wet trail or playing basketball. If you are visiting the island, we see you too: see care for visitors.

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A doctor visit costs US$79, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note is included. We do not bill insurance; the X-ray and the pharmacy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

The most common signs of an ankle sprain are:

• Ankle pain, especially when you put weight on the foot
• Swelling
• Bruising or color change
• Trouble moving the ankle or walking
• A "pop" or tearing feeling at the moment of injury

For a mild sprain, follow this MedlinePlus advice:

• Rest the ankle for the first days. Then put weight on it little by little, as the pain allows.
• Ice: on the first day, 20 minutes every hour while you are awake; after that, 20 minutes 3 to 4 times a day. Never put ice directly on the skin: wrap it in a cloth.
• Compression with an elastic bandage, not so tight that the foot gets cold or numb.
• Elevate the foot on a pillow, at or above the level of your heart.
• For pain, over-the-counter ibuprofen or naproxen can help; ask the doctor first if you have heart disease, high blood pressure, kidney or liver problems, or a history of ulcers. Acetaminophen is another option.

Pain and swelling usually improve within 48 hours. With a mild sprain you are back to normal in a few days; a severe one can take several weeks.

When do you need an X-ray? The doctor recommends one when she suspects a fracture: for example, if you could not walk after the injury or a bone is very tender to press. We do not do X-rays: we refer you to a place near you. If you are not better in 5 to 7 days, walking is still very hard or the ankle feels unstable, see us again. If what hurts is the bottom of your heel with your first steps in the morning, see plantar fasciitis.

Children and teens sprain ankles playing and in sports too. The doctor sees children of all ages by video; patients under 21 need a parent or legal guardian on camera for the whole visit, with ID. If your child cannot put weight on the foot or the pain keeps them up at night, for their safety have them seen in person. For return to sports, the American Academy of Pediatrics advises going in stages: first control the swelling, then rebuild motion, strength and balance.

For your safety, do not wait for a video visit: go to in-person urgent care or the emergency room if you have any of these signs. If the injury is severe, call 911. See when to go to the ER.

• You cannot put weight on the foot or take a few steps
• The ankle looks deformed, twisted or out of place
• Numbness or tingling in the foot
• The foot is cold, pale or bluish
• Very severe pain that does not ease with ice and rest