The goal is in front of you. It’s not yet close enough for the soccer ball to go straight in, but it will be soon. You pick up speed. Someone intercepts. You pass the ball from your right leg to your left and then back to the right, going through the maze of defenders in confident zigzag motions. And then---
This part may happen in slow motion. Your right leg is still positioned to pass the ball to the left. The foot is turned inward. It’s the bent outer side that hits the ground instead of the more flat and stable bottom. Your body knows that it’s falling and tries to twist itself upright-- except the unstable foot is in the way. And then it twists.
Or that part may happen in the blink of an eye. There’s only half a second between being completely fine and landing on the floor, pain searing at the ankle.
Or, at least, you think it’s a sprained foot. It makes sense since a sprain is the most frequent injury sustained in sports with a high rate of recurrence. It’s also known as an acute ankle sprain where one of the ligaments of the foot is injured. These injuries can be small microscopic tears and often affect a certain anterior talofibular ligament-- which is the weakest ligament of the bunch and is responsible for around 70% of these sprains.
The seriousness of an injury largely depends on a few factors including how high the energy impact was, the position of the foot when it twisted, the force of rotation, and how stable the ligaments were in the first place. And if it’s actually a sprain.
Though fractures tend to be more painful and cause greater soft tissue deformities, it might not always be evident to someone who isn’t trained to recognize these. It’s always best and safest to have the injured foot checked by your local healthcare practitioner so as not to miss any worrisome problems.
They might follow the Ottowa Ankle Rule to determine whether this is a simple sprain or a fracture that would require an X-ray series. What are they looking for with the Ottowa Anke rule?
They will likely touch specific parts of the foot to test whether there is tenderness— this is different from the soreness or pain that comes with the sprain. It is likely sharper and will make you jump a bit when they touch the area. This tenderness could be a sign of a fracture. Besides this, they might ask you to walk as best as you can. Someone unable to walk at least four steps at the time of the check-up has a higher chance of having a fracture instead of a sprain.
There, the treatment diverges. Fractures require more care for the bones to heal properly. Whereas, a sprained foot can be managed at home. There is a simple and easy-to-remember mnemonic for a sprained foot treatment at home. The mnemonic is “PRICE”.
P is for Protect. Complete immobilization of the foot is not often necessary-- but the joint should be handled with care. Further trauma to an already sprained foot can aggravate the damage and delay healing. But the protection doesn’t stop once the immediate pain is done and one can start walking on a sprained foot.
Studies have shown that a previous lateral ankle sprain can cause chronic instability and increase the chances of another sprain happening again. No one wants to go through that. Wearing ankle braces when participating in physical activities can help increase joint stability and decrease the chances of another sprain. Of course, it would be best to consult with an expert on the fit of these braces as an ill-fitting one may make things worse.
R is for Rest. Resting the sprained foot is particularly important for the first 72 hours following the injury. As in the earlier paragraph, bearing weight on the joint may just cause more damage. However, after this three-day rest period is up, one can resume activities as tolerated. You can start with some gentle range of motion exercises, ideally under the guidance of a trained professional. Should there be any mild discomfort, over-the-counter painkillers could usually do the trick.
I is for Ice. Where there is injury, there is swelling or discomfort. Placing an ice pack wrapped in a clean towel over the area usually does the trick! The recommendations mention placing the ice pack around three times daily, for about 10-20 minutes each time.
C is for Compression. But I tend to put a pin on this recommendation. It is a bit tricky to teach someone how to wrap a sprained foot with elastic bandage over the internet. Without a demonstration and return demonstration, it’s difficult to say if someone is doing the right thing--- and the consequences might lead to worse damage or a decrease in blood flow if the wrapping is too tight. Studies have not been able to conclusively show decreased swelling, pain reduction, or better joint function when compression was done compared to when it was not.
Compression is still part of the standard of care when treating sprains. But for home care without proper guidance and with little evidence of improvement, we might be okay with skipping this one step.
E is for Elevation. We spoke about swelling earlier on which is part of the body’s natural reaction to an injury. This can go away on its own but the process can be sped up-- by ice or by elevation. You need to rest the injured foot at a spot that puts it higher than the level of the heart. Imagine lying flat on your back while having a small stack of pillows to lift your foot higher. This should be done as frequently as needed during the first 48 hours to encourage the fluid to return towards the heart.
How long is the usual foot sprain recovery time? Some studies have shown that it took at least six weeks for the affected ligament to properly heal-- sometimes as much as three months. Even then, some patients still observed some instability in the joint.
The goal is in front of you. The road to recovery may seem long but it starts out simple enough-- protection, rest, ice, compression, and elevation.
- Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
- Hubbard TJ, Wikstrom EA. Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access J Sports Med. 2010;1:115-122. Published 2010 Jul 16. doi:10.2147/oajsm.s9060
- Borra V, Berry DC, Zideman D, Singletary E, De Buck E. Compression Wrapping for Acute Closed Extremity Joint Injuries: A Systematic Review. J Athl Train. 2020;55(8):789-800. doi:10.4085/1062-6050-0093.20