Sprained ankle: treatment, healing time and when to see a doctor

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.

Video doctor visits 24/7 — book online and choose your time right away.

To help the doctor evaluate you well by video, have these ready. Not sure whether a video visit or an in-person visit is right for you? Read telehealth or in-person visit: how to choose and how to prepare for your video visit. When you are ready, book your visit.

• How and when you twisted it
• Whether you can put weight on the foot and take a few steps
• Whether the ankle looks deformed, bruised or very swollen: show both ankles on camera to compare
• Whether you feel numbness or tingling in the foot
• Your medicines and allergies
• Someone to help you move the camera if moving is hard

A doctor visit has 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 clinic can’t see you. 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 NSAIDs such as 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 (see the Ottawa ankle rules below). 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. If it was your knee that twisted rather than your ankle, see knee pain.

To decide whether you need an X-ray, doctors use the Ottawa ankle rules, validated in a study published in JAMA (Stiell and colleagues, 1993). Under those rules, you need an X-ray if you have pain around the ankle and any of these signs:

• Bone tenderness along the back edge or at the tip of the outer ankle bone (the lateral malleolus), over the last 6 centimeters (about 2.4 inches).
• Bone tenderness along the back edge or at the tip of the inner ankle bone (the medial malleolus), over the last 6 centimeters (about 2.4 inches).
• You could not take 4 steps on the foot, both right after the injury and when you are examined, even with a limp.
• In the foot: tenderness at the base of the bone on the outside of the foot (the fifth metatarsal) or at the navicular bone, on the inner side of the midfoot.

By video, the doctor guides you to press on those points on camera and asks you to try 4 steps. If any rule is positive, you need an in-person X-ray, and we refer you to a place near you. If none is positive, a fracture is unlikely and it can usually be cared for at home; if you are not better in 5 to 7 days, see us again. The rules were studied in adults; for children the doctor decides case by case.

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