Sprained ankle recovery: the first 72 hours and getting back to sport

You rolled your ankle stepping off a curb, landing a rebound or on a trail. It swelled, it bruised, and now you want to know how to get it right as fast as possible. Here’s a practical plan, based on the clinical guidelines for ankle sprains.

First: is it broken?

Most twisted ankles are sprains, but some are fractures. If you can’t take four steps, or if there’s tenderness directly over the bony bumps of the ankle or the outer edge of the foot, get an X-ray. Our article sprain or fracture? explains the checks doctors use.

Days 1 to 3: protect and calm it

• Protect it with a lace-up brace, a stirrup brace or elastic support.
• Ice for 15 to 20 minutes a few times a day and elevate the ankle above your heart when you can.
• Anti-inflammatory medicine can help with pain and swelling if it’s safe for you.^[1]
• Walk as pain allows. Guidelines favor early, protected movement over keeping the ankle still.^[2]

Week 1 to 2: get it moving

• Range of motion: trace the alphabet with your big toe, several times a day.
• Gentle calf stretch once walking is comfortable.
• Keep walking in a supportive shoe, gradually reducing the brace for daily activities.

Weeks 2 to 6: strength and balance

This is the stage people skip, and it’s the one that matters most for preventing the next sprain.^[1]

• Resistance band exercises in all four directions: up, down, in and out.
• Heel raises, two feet, then one foot.
• Balance: stand on the injured leg for 30 seconds. When that’s easy, close your eyes, then stand on a pillow, then play catch while balancing.^[2]

Return to sport

Base the decision on what the ankle can do:

• You can walk, jog and run straight without a limp or pain.
• You can hop on the injured leg, land softly and repeat.
• You can cut, pivot and change direction at speed.
• Strength and balance are close to the other side.

For many mild sprains that takes a couple of weeks; more severe sprains can take six weeks or longer. Wearing a brace for sport in the months after a sprain reduces the risk of doing it again.^[1]

When a sprain isn’t getting better

Most sprains improve steadily. If yours isn’t, there may be more going on: a fracture that was missed, a cartilage injury inside the joint, a peroneal tendon tear, or ligaments that have healed loose. An international consensus of ankle specialists counts ongoing instability among the long-term consequences of sprains, along with reduced activity and earlier arthritis.^[3] See our pages on ankle sprains and instability and cartilage injuries.

For athletes, our sports medicine team builds a return-to-play plan around your sport.

When to see a podiatrist