Have you just now suffered a sprained ankle? RICE is the acronym for you - stick it in the air, higher than your heart, covered with ice blocks wrapped in a wet towel.

Alternatively, stick it in a bucket of water with ice, or pour methylated spirits on firm bandages.

The window of opportunity for this to help is brief - possibly half an hour.

This will do no harm even if you have a malleolar (ankle bone) fracture. If your foot pain is severe and your foot very swollen and sitting on an odd angle, there is not much point in delaying getting help, however.

You may be able to tell you have a (less obvious) fracture, by finding tenderness on rubbing up the back of your ankle bones, where no ligaments attach.

A sprained ankle will be tender at the front and sides of the ankle bones.

How to tape an ankle you've twisted, but can stand on.

We usually sprain the ligament on the outside of our ankle, by catching our little toe on something.

Usually the best sprained ankle treatment is to strap it up tightly and keep walking, as normally as possible.

Bandages to use

A 3 inch wide crepe bandage is the minimum strength required. A bandage of slightly heavier material and which adheres to itself but not to your skin, is the PEG bandage. This is very good, but you can more easily apply too much pressure with it.

A little padding can be laid on the skin below and up in front and up behind the ankle bone, to fill in the hollows here and even out the pressure.

Bandaging technique for sprained ankle

Rest your heel on the edge of a stool, and hold your ankle at a right angle (90 degrees.)

If you have sprained the outer side of your ankle, the bandage should be laid in the direction from your little toe towards your big toe, across the top of your foot just behind your toes.

Hold the free end near your little toe as you apply the first turn, until you have overlapped it enough for it to hold. Now put another turn right on top of this first one, so you have now gone twice around the front of your foot.

This should anchor it so that you can pull it tight without it slipping.

When you bring it to the top of your foot for the second or third time, angle it upwards across the front of your ankle, ensuring that it is spread out quite flat.

Take it around the back of your leg just above the ankle and then angle it down again, crossing over in front of the ankle.

Then around your forefoot a quarter to half an inch (one cm.) behind the first two turns.

You have now formed a figure of eight or infinity symbol with the bandage.

As the bandage is pulled around from under your little toe, lay it parallel to the first turn about half an inch above it.

Ensure that your ankle is still at a right angle.

It needs to be pulled on quite firmly, at the same time as ensuring that it is laying quite flat, with no turning in of its edges.

Then around the leg again and down across the front of the ankle, again a little above the last turn and parallel to it.

Around the foot again and you now have two figures of 8.

Make the spacing between the turns such that you can fit in three of them as in the picture.

You should see them crossing in the middle of the foot as in the picture.

Bandaging technique for sprained ankle

All these turns are put on quite tightly.

You should (unlike in the picture,) have enough left for two turns around the leg to finish. These are not tight, just slightly firm.

Stand up and walk. Your sprained ankle should feel better.

If your toes go blue, take off the bandage and start again, using less tension.

Overnight treatment

Once you are off your feet and can put it up, there is no need for the tight bandage.

Aloe vera gel is quite useful. Put cling wrap plastic over this, then a sock or stocking. The oil out of vitamin E capsules is also good.

Taping and functional bracing

Short term support is commonly used in athletes, during recovery. Provided the exercises are done as well, this need not result in weakness of muscles.

It is certainly very important to avoid repeated sprains, which could result in a ligament healing lengthened and lax.

The tape used now adheres to the skin, so it cant move when running. It includes pieces which pass straight down over the ankle bone, under the heel and up the other side, pulled tight so as to help prevent the ankle turning in. This needs some experience.

Ideally the pull of the tape on one's skin should provide a warning of movements which could result in re-injury.

Functional braces such a the Aircast Air-Stirrup ankle brace, allow the foot to move up and down but help prevent the ankle bending in or out.

A bit of belated background blurb - your ankle anatomy

Technically your talocrural joint, comprised of three bones - your shin bone, the fibula and the talus.

Your body's weight is taken by the talus and tibia, and the fibula is just there to ensure the other two stay together.

The tibia and fibula form a mortise joint for the talus, holding it just as you hold a glass between thumb and forefinger.

The ankle ligaments holding the talus in this grip, are what you sprain, or even tear completely. Special imaging is needed to confirm complete tear, if this is suspected.

The talus has a rounded top, and rocks back and forward in the mortise. When this rounded talar dome is fractured it is not always that obvious, even on a plain X-ray. this is something to ask about if a badly sprained ankle is not improving.

Your talus sits like a keystone at the top of the arch over a doorway...

Its joints with the heel bone and navicular bone, allow side to side rocking. Together with the ankle joint, these amount to a universal joint between the foot and leg.

Your subtalar joint may be involved as well, in severe sprained ankle

Can you rock your heel from side to side without pain, even if pushed to its limit.

This should not hurt in an uncomplicated sprained ankle, whereas pulling your foot down by your little toe should hurt a lot. This last action is the same movement which caused the damage.

If you think your subtalar joint is involved, consult a professional to check.

Other complications - further injuries up the "closed kinetic chain"

Forces applied to your foot are transmitted up the limb. You can fall on your feet and break your back!

The first spot is the joint at the upper end of the fibula, immediately below your knee.

Joints in your back are more likely to be sprained...

This is an example where the ankle was bruised rather than sprained...

“Ken,” aged 87 years, came to see me with a badly bruised ankle. He had jammed his foot in a door to stop it slamming on his small dog.

10 days later he requested an X-ray as he was no better and he suspected a fracture.

I saw him three days after the x-ray. It only showed “minimal osteoarthritis” at a couple of joints. The pain was worse.

On examination, he had “brush allodynia” over the skin above the ankle. The initial swelling had largely subsided.

On examination of his spine, the last joint of the lumbar spine, was stuck on one side.

This joint was mobilized and he went away pain free and very happy.

Extra pain from pre-existing calf muscle tightness

The peroneal muscles are likely to be tender from the sudden stretch involved in spraining your ankle.

These are on the outer side of your leg, between knee and ankle.

The main calf muscles should not be involved, and tenderness here is likely to have been there before.

Standing calf stretches may not be possible, but someone can stretch the calf for you, laying down on your back.

They need to form a gutter between their fingers and thumb, to grasp your Achilles tendon just above your heel. The base of their thumb and their little finger contact the top of your heel bone, where the pull is applied.

handgrip for Achilles tendon to stretch calf

Ankle exercises and ankle rehab for sprained ankle

With lateral malleolar pain ligament damage is very likely to be only a partial tear of the ankle ligaments which will heal without leaving weakness.

It is possible for someone to sprain their ankle and continue to limp slightly, as a habit, after it has healed.

Make an effort to walk as normally as possible, during your ankle sprain recovery.

It's really important to keep your lateral calf muscle working well. A balance board is very valuable for this.

Balance board for ankle exercise

This is made of some board strong enough to stand on without breaking it. The board acts like a see saw. Stand on it alongside something to put your hand on to steady yourself. Slowly rock side to side as you watch something on TV perhaps.

This will strengthen the muscles which protect you from spraining your ankle, and will help to restore normal feeling in the joints and muscles here.

Standing on that foot on soft foam or jumping on it on a trampoline are good balance exercises too.

Osteoarthritis of your ankle joint, longstanding pain here

This is here for location, location, location.
It's not usually a complication of sprained ankle, except when associated with talar dome fracture in the past.

It's more related to overweight, usually.

The main site of tenderness is in front of the joint.
If you feel right in the angle between the top of your foot and the front of your leg, there is a groove across, between your leg bone and the talus.

The same test is applied as elsewhere, rubbing firmly to see if the groove (joint) is more tender than adjacent bones above and below.

In sprained ankle and in osteoarthritis, the joint is likely to be the most tender.

Most of the measures on the knee osteoarthritis treatment page , apply to osteoarthritis here as well.

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2013 guidelines for treating and preventing ankle sprains in athletes

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