Sprained your ankle? Now what?

You step off a curb, land wrong after shooting a basket, stumble on uneven ground, and ouch! Your ankle tells you something is wrong. That something may be an ankle sprain, which happens when you roll your ankle inward, excessively stretching the ligaments supporting the joint. An ankle sprain is the most common injury among athletes and weekend warriors, but it can happen to anyone who's active or simply takes a misstep.

What to do right after a sprain

While common, ankle sprains can lead to chronic issues, such as ankle instability and degenerative arthritis, if not treated properly. Also, tendon injuries, cartilage damage or even fractures may be missed if a severe sprain is ignored.

If you've sprained your ankle, immediately begin following the memory device "RICE" (Rest, Ice, Compression, Elevation) to minimize the risk of complications and long-term issues:

• Rest
  Discontinue the activity that caused the injury for the rest of the day and minimize walking.
• Ice
  Apply ice to the area, typically for 15 minutes on, 15 minutes off, as much as possible for the rest of the day. Afterward, continue with 15 minutes of icing three times per day until the pain and swelling subside.
• Compression
  A compression sleeve, wrap or brace over the affected ankle can prevent inflammation and protect the area from repeat injuries.
• Elevation
  Elevate the extremity at or above the level of the heart as often as possible for the rest of the day to reduce pain and swelling.

Depending on the severity of your symptoms, for the first one to two weeks:

• Continue with RICE.
• Take over-the-counter medications, such as ibuprofen, naproxen or aspirin, if you can safely take them.
• Start resistance-free, range-of-motion exercises, such as drawing each letter of the alphabet with your foot. This can help prevent long-term stiffness, fight swelling and help the stretched ligaments heal. Don't do an exercise if it causes increased pain.

If there's little or no improvement after the first week, consider following up with a health care professional, such as your primary care provider, sports medicine specialist or physical therapist.

Sometimes it's better to see a provider as soon as possible following the injury. This may be necessary if you:

• Aren't able to bear any weight on the ankle two days after the injury.
• See notable deformity in how your ankle looks.
• Heard or felt a pop or crack during the injury.
• Have lost sensation in your foot.
• Can't move your foot in a certain direction even after swelling has been controlled.

What to expect for recovery, additional treatment

Once you've passed the initial recovery period, further treatment depends on the extent of the injury. For straightforward injuries that didn't require evaluation by a health care professional or involve any setbacks, you can expect symptoms to last 10 to 12 weeks. This is how long it can take for a ligament to repair.

Keep in mind that once a sprain has occurred, the ankle is more susceptible to repeat sprains in the future. Using an ankle sleeve or brace can provide added support and stability.

If you suffered a more significant sprain and saw a provider for it, you may experience a slower, longer recovery that could include:

• A period of immobilization and nonweight-bearing
• Protected weight-bearing in a tall walking boot
• Physical therapy to help increase stability, strength and balance
• Surgery

If your health care professional suspects the injury requires surgery, either due to the initial injury or lack of recovery, you will undergo X-rays and possibly an MRI to determine the extent of the damage. Then you'll consult with a surgical podiatrist or orthopedic surgeon.

You may need surgery if there is:

• Evidence of a complete rupture of one or more of the lateral ankle ligaments, requiring repair.
• Extensive history of recurrent sprains and ligament reconstruction is needed.
• An associated injury, such as a partially or completely torn tendon, a fracture, or damage to cartilage in the ankle joint.

While sprains are common, they do need to be properly addressed so that you can regain your best level of activity.

Brandon Lee, D.P.M., practices podiatry and foot and ankle surgery in La Crosse and Sparta, Wisconsin.