Twisted Ankle Injury

What is a twisted ankle?

The most common injury from a “twisted” anything is known as a sprain/strain injury. These injuries occur to the soft-tissues (muscle, ligament, tendon) and have 3 categories ranging from a 1st degree (stretched), 2nd degree (partial tear), to a 3rd degree (full tear) injury. Neither of the above injuries is pain-free, however, the latter will usually require surgical repair. Fortunately, the majority of cases are 1st and 2nd degree sprains that will require a 4-12 week timeframe for full healing.

When do you need to get an x-ray for a sprained ankle?

A set criteria of x-ray consideration known as the Ottawa Rules is commonly used in emergency medicine to determine the necessity and likelihood of boney injury. Below is a summarized and generalized version of those rules.

Ottawa Rules (summarized and generalized)

-Patient’s 1st injury of ankle sprain

-Point tenderness to the inside or outside bones of the foot or ankle

-Inability to walk on the foot

What can I do at home to treat a sprained ankle?

Immediately following the injury-the injured ankle will begin the healing process with the inflammatory phase of healing. This causes all the pain and swelling but is a necessary evil to start the healing process. You can help yourself by limiting the body’s inflammatory reaction. Too much inflammation will actually slow the process.

  1. Do not put heat on the foot/ankle within the first 72 hours!
  2. Follow the RICE treatment protocol until swelling dissipates.
    1. Rest-reduce walking activities to the ankle.
    2. Ice – for 10 minutes per hour followed by Ankle Circles.
    3. Compression-bandage the ankle from the base of your toes to the sock line.
    4. Elevation – elevate the ankle to heart level to reduce swelling from pooling in the ankle.

Ankle circles – Holding a towel at opposite corners, wrap the towel around the foot and crisscross the ends. Pull back on both ends of the towel to stretch the ankle backward. Attempt to move the ankle in large circles using the towel to assist the ankle backward, in and out.

What can I do to return to activity ASAP?

Early movement (except for fractures!) will speed the healing process. A milk massage may reduce swelling into the foot/ankle. A “milk” massage is a gentle massage that “pushes” swelling out of the foot/ankle and into the calf. Any lotion can be used. The name “milk” is used to describe the process of moving the fluid from one area to the other via a milking process. So please, don’t use milk!

In addition to early movement and milk massage, towel strengthening exercises and standing kick balance exercises can be used to improve strength and balance-to improve your bodies spatial awareness for return to sports activities. These exercises will reduce the likelihood of re-injury when returning to sports. In addition, wearing a brace for the 1st 2-4 weeks of return to play will assist in protecting the ankle from re-injury.

Towel exercises – lay a towel to the side of the foot and by keeping the heel of the foot planted, gently twist the foot onto the towel and drag it toward the foot. Repeat until the towel is completely pulled in, and then lay it out again. Repeat for both sides of the ankle.

Standing Kick Balance Exercises-while standing on a pillow (an unstable platform), slowly kick forward and pause to regain your balance, repeat kicking in different directions. Note—you stand on the bad ankle and make it work to keep you balanced!

What is the difference between an ankle sprain and a “high” ankle sprain?

A “high” ankle sprain is actually an injury to the ligaments that connect the lower leg bones just above the ankle joint. This injury tends to take a much longer time to recover due to the high forces applied to it when someone is in a weight-bearing stance.

Dr. Custer is the owner/operator of Better Care Chiropractic & Physical Therapy. Dr. Custer graduated from Texas Chiropractic College in 2005 with highest honors, Summa Cum Laude. He combines his 25 plus years of experience in injury rehabilitation (as an athletic trainer) with his chiropractic education to promote a fast and efficient recovery process.

If you have questions/comments/suggestions, please feel free to contact Dr. Custer at