Emergency and Urgent Care - Managing ankle injuries

You have an ankle sprain, which means you have injured the ligaments around your ankle.

The ankle will be painful, bruised, swollen and can take up to 6 weeks to recover.

What should you do?

For the first 2 days: Follow the “PRICED” advice.

P = Protect: Avoid activities that will cause further injury to your ankle. Walking within pain limits is ok.
R = Rest: Partial rest is recommended, but you can move the ankle as pain allows, aiding your recovery. See exercise 1.
I = Ice: A bag of ice/frozen peas/ice pack wrapped in a towel can be applied for 15 minutes, every 2 hours, to reduce pain and swelling.*
C = Compression: You may use a brace/support to reduce pain and swelling.
E = Elevation: Elevating the foot/ankle above heart level will reduce swelling.
D = Drugs: Sensible use of simple painkillers is recommended, e.g. paracetamol.**

* Warning: Check the skin after 5 minutes for ice burn. Do not use if you cannot feel the sensation of hot/cold on your joint.
** Warning: Follow patient information advice leaflet found in all medicines.

Avoid “HARM”

H = Heat: Hot baths, saunas and heat packs will increase bleeding/swelling.
A = Alcohol/Smoking: Reduces healing and increases bleeding/ swelling.
R = Running: Or any form of exercise which may cause further injury.
M = Massage: May increase bleeding and swelling.

After the first 2 days: Get the ankle moving. Exercise really helps your injury to recover!

Your goals initially are to:

1. Start walking and increase time on your feet as pain allows.  You may have been given a boot/crutches/both. Put weight on the injured ankle as pain allows. Slowly stop using these aids and build up walking without them gradually over 3-7 days.
2. Regain movement, build up strength and balance.

Exercises: 

• These exercises will be most effective if completed ‘little and often’
• You can do these exercises every 2 hours
• Remember to start exercising slowly and build up gradually
• Patients tell us that initially their pain can increase but this will settle within a few days of starting the exercises
• Consider appropriate footwear: Supportive shoes or lace up boots that go above the ankle are best

A brace or ankle support can be used for the first 2 weeks.

Returning to physical activity: work, hobbies and sport

• Returning to sport and work will depend on the demands of your job and chosen hobbies
• Recovery is faster if you stay at or get back to work as early as possible:
• If you are on your feet all day you may need to gradually return to work, do lighter duties to start off with or have regular breaks to elevate the foot/ankle.
• Once you have regained movement, strength and balance, you can slowly start to increase your activity back to your previous level

Physiotherapy

If you are unsure about what to do and feel you need support with your rehab, you can see a Physiotherapist.

If you live in Salford or are registered with a Salford GP, you can now refer yourself at www.northerncarealliance.nhs.uk/ go2physio. Alternatively, your GP can refer you if you are unable to use the online form or live outside of Salford.

What should you watch out for?

See your GP or a physiotherapist if you experience any of the following:

• You get bruising on the sole of your foot
• Your pain is getting worse not better after 2 weeks
• You get numbness or pins and needles in the injured ankle that has not improved after 2 weeks
• You continue to injure or go over on your ankle repeatedly and don’t trust it
• You are not back to normal after 6 weeks

Remember...

• Ankle sprains can be very painful
• Most ankle injuries will recover within 6 weeks
• Early exercises will aid your recovery and reduce the risk of re- injury
• Consider referring yourself to the go2physio service

Website: www.northerncarealliance.nhs.uk/go2physio.

Further advice and guidance can be found on social media, but we recommend:

Versus Arthritis - ankle sprain advice - https://www.versusarthritis.org/media/21785/anklesprains-  exercise-sheet.pdf -
NHS sprains and strains advice - https://www.nhs.uk/conditions/sprains-and-strains/
NICE sprains and strains - https://cks.nice.org/uk/topics/sprains- strains/#

Emergency Department Trauma and Orthopaedics
Radiology & Musculoskeletal Physiotherapy Services Telephone: 0161 206 4892