Ankle sprain

First we ask how the ankle rolled, whether you could walk on it afterward, and whether you have sprained it before. Then we look at the swelling and bruising, and find where it is tender. We test the ligaments on each side of the ankle. We also check the ligament just above the ankle that joins the two lower leg bones (the syndesmosis), because a twisting fall can hurt it.

We look for signs of a broken bone (fracture). If one is possible, a doctor or nurse practitioner needs to see you first, and may order an X-ray, before rehab goes further. Then we test how the ankle moves, how it takes weight, and your balance on each leg.

Early on, the aim is to protect the ankle but keep it moving. A brace or tape protects the ligament while the swelling settles, and some people need crutches for the first days. We get you walking, within comfort, as early as the ankle allows.

Rehab then builds in stages:

• Movement: getting the full bend back at the ankle, which you need for squatting and walking downhill.
• Strength: the calf, and the muscles on the outside of the lower leg that turn the foot back out when it starts to roll.
• Balance: standing on one leg, then on a soft surface or with your eyes closed, then hopping. This trains the ankle to react quickly on uneven ground.
• Sport drills: hopping, landing and changing direction, then work on rough ground.

Balance training is the part people most often skip, so we build it in from the start. Hands-on treatment can ease stiffness along the way. For ankle braces, see splints and bracing. Once you are hopping and landing well, strength and conditioning can take the work further.

Your return is guided by how the ankle tests, not by the calendar. We check hopping, landing and balance on the injured side against the other ankle. Then we practise the ground your sport brings: rocks, roots and loose dirt on trail descents, or jump landings in the bike park.

We can show you how to tape the ankle, or help you choose a brace, for your first outings back.

Book an assessment soon after a sprain that makes you limp. Come in too if the ankle stays swollen, stiff or sore, feels unsteady on rough ground, or has been sprained more than once.

See a doctor or nurse practitioner first if the bony knobs on either side of the ankle hurt to press. The same applies to the bones halfway along either edge of the foot. These can be signs of a broken bone, which needs an X-ray.

Go to the emergency department right away, or call 911, if any of these happen:

• the ankle looks out of shape
• you cannot put weight on the leg, even for a few steps
• your foot is numb, cold or pale