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June 12, 2023

‘I Rolled My Ankle.’ Now What?

by Ashley Fields, MD, CAQSM

Maybe you were playing sports or jogging in your neighborhood. Or maybe you just stepped off a curb without paying attention and – ouch. You rolled your ankle.

A rolled ankle is a common type of ankle sprain that occurs when the foot rolls inward, damaging the ligaments of the outer ankle. A rolled ankle typically results in what’s called a “lateral” ankle sprain.

Of the over 2 million ankle sprains that occur every year in the United States, about 85 percent are lateral sprains.

Every spring, Dr. Ashley Fields, a board-certified family physician and sports medicine specialist for Avance Care, says she sees an uptick in ankle injuries as people head outside for more activities.

“We see a lot of lateral ankle sprains this time of year. They’re some of the most common injuries we see in the primary care setting,” Fields says.

Dr. Fields shared more about the symptoms of a lateral ankle sprain, how to take care of an ankle sprain at home, and when you should see a doctor if you think you’ve sprained your ankle.

What is a lateral ankle sprain?

It’s when you sprain the ligaments in the lateral ankle complex. That includes your anterior talofibular ligament, or ATFL, your calcaneofibular ligament, or CFL, and your posterior talofibular ligament, or PTFL. More than 90 percent of the injuries we see to the lateral ankle complex are to the ATFL alone.

What is the function of the ATFL ligament?

Ligaments are the fibrous bands of tissue that connect bone to bone, and they help provide joint stability. Anytime you invert your foot or roll your ankle, you’re putting stress on those ligaments, which puts more load or tension on that ligament. It tends to be very common in high velocity sports like soccer, basketball, and volleyball. We see a lot of injuries on turf, too, but ankle sprains can happen doing everyday activities as well.

What are the symptoms of a lateral ankle sprain?

When one or more of the ligaments in the ankle are stretched or torn, it can cause pain, tenderness, swelling, bruising, a restricted range of motion, and difficulty walking.

Are lateral ankle sprains graded in terms of severity?

Yes. There are 3 grades we use when you sprain your ankle. Grade 1 is a very mild injury. You’ve irritated the ligament and maybe have some minimal tearing of the ligament fibers. You may see a little bit of swelling and pain in that area. You can usually be back at your full capacity and back to sports between 3 to 4 weeks.

With a Grade 2 injury, you’re looking at more of a moderate ankle sprain. That’s where you see more significant swelling and bruising because of the more significant tearing of the ligament fibers. Your recovery stage is going to take longer. You can expect 2 to 3 weeks of significantly limiting your activity, but you tend to be back at full capacity at about week 6.

Then there is Grade 3, which is a severe ankle injury, and a complete tear of the ankle ligament. With that, you are looking at about 16 weeks of recovery.

Do ankle sprains often require surgery?

Usually if you just sprain your ankle, no, especially with Grade 1 and 2 injuries. When we start getting to the Grade 3 injuries, if you fail conservative treatment and you’re not getting any better, that would be a discussion to have with a surgeon. But most ankle sprains heal without any surgery.

How do you treat of an ankle sprain at home?

We follow a mnemonic, POLICE.

P – Protect

OL – Optimal Load

I – Ice

C – Compress

E – Elevate

Within the first 24 to 72 hours, we ask that you Protect the ankle, so it doesn’t get injured any more. Maybe you use crutches.

OL is Optimal Load. You want to keep trying to put a little bit of weight on the ankle to help stimulate the healing process, but not more than you can tolerate. Go easy.

I stands for Ice. I like a bag of frozen vegetables because you can manipulate it to the shape of the ankle, and that will help with the pain and swelling.

C is for Compression which helps with swelling. E is for Elevation which also helps with swelling.

Also, during that time, we recommend an anti-inflammatory like ibuprofen, such as Motrin or Advil, or you can use acetaminophen, like Tylenol. We really don’t recommend an opioid. Chances are we would not prescribe that.

How do you know when you should get a sprained ankle checked out by your primary care doctor?

Some people shrug off ankle injuries and don’t see a doctor. But if an ankle sprain is painful or swollen, it’s important to see your primary care doctor. You want to make sure you don’t have a fracture or other injury to the foot or ankle, and to make sure you know how to take care of the ankle, so it heals properly.

I always tell people to see us if you have any concerns. It’s better to have us put our eyes on it to make sure everything is OK. Especially if you are noticing you’re not getting better after trying POLICE, or if you have any bone tenderness, or if you are unable to walk 3 or 4 steps at a time, it’s best to come in.

I’m a very strong advocate to bring in children if they injure their ankle. Children have growth plates, so we do need to make sure there isn’t an injury to a growth plate.

When you roll an ankle, there are other ligaments that can be affected. We also want to make sure you don’t have a fracture, or an osteochondral defect, which is damage to the cartilage and bone.

We also recommend you don’t try to play through an ankle sprain. Give your ankle a chance to rest and heal before you resume your normal activities to avoid putting yourself at risk of future injuries. For more severe ankle sprains, you may need rehabilitation to help restore normal range of motion and strengthen the muscles of the foot and ankle. By giving the ankle time to fully heal, you have excellent chances of making a full recovery.

Check out the video version of this interview here.


1. Epidemiology of sprains of the lateral ankle ligament complex.

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