Quick Answer
See a doctor if you cannot bear weight on your ankle, have severe swelling or bruising, visible deformity, or pain that doesn't improve within 3-5 days. Seek immediate care for severe trauma, inability to walk, or ankle that looks misshapen.
🚨 Seek Immediate Medical Care If:
- Obvious deformity - ankle looks crooked or misshapen
- Bone protruding through skin (open fracture - emergency)
- Complete inability to bear weight or take any steps
- Severe trauma from car accident or fall from height
- Numbness or tingling in foot that persists
- Signs of infection: Fever, red streaks, severe warmth
📅 Schedule an Appointment Within Days If:
- • Pain or swelling not improving after 3-5 days of RICE
- • Difficulty walking or bearing weight (even partially)
- • Significant bruising spreading beyond ankle
- • Ankle feels unstable or gives way when walking
- • Pain when pressing on bones (suggests possible fracture)
- • Recurring ankle sprains or chronic instability
- • Pain in Achilles tendon area, especially with activity
- • Morning stiffness lasting more than 30 minutes
🔍 Sprain vs. Fracture: Key Differences
Ankle Sprain (Ligament Injury)
- • Can usually bear some weight (with pain)
- • Swelling around sides of ankle
- • Bruising may develop over 1-2 days
- • Pain mostly with movement
- • May feel “rolling” sensation at injury
- • Improves gradually with RICE
Ankle Fracture (Broken Bone)
- • Usually cannot bear weight at all
- • Immediate severe swelling
- • Rapid bruising
- • Pain even at rest
- • May hear “snap” or “crack” at injury
- • Tenderness directly over bone
If unsure, get X-rays - fractures need different treatment!
Common Causes of Ankle Pain
Acute Injuries
- • Ankle Sprain: Most common - ligament stretching/tearing (usually lateral)
- • Fracture: Broken bone in ankle (fibula, tibia, or talus)
- • Achilles Tendon Rupture: Complete tear, sudden “pop” sensation
- • High Ankle Sprain: Injury to ligaments above ankle joint
Chronic/Overuse Issues
- • Achilles Tendinitis: Inflammation from overuse, tight calves
- • Posterior Tibial Tendinitis: Inside ankle pain, flat foot
- • Peroneal Tendinitis: Outside ankle pain from overuse
- • Ankle Arthritis: Cartilage wear causing pain and stiffness
- • Tarsal Tunnel Syndrome: Nerve compression causing numbness
Home Treatment: RICE Protocol
For mild ankle sprains without red flags, follow RICE immediately:
R - Rest
Avoid bearing weight for first 48 hours. Use crutches if needed.
I - Ice
Apply ice 15-20 minutes every 2-3 hours for first 48-72 hours.
C - Compression
Use elastic bandage or ankle sleeve (not too tight - check circulation).
E - Elevation
Keep ankle raised above heart level when resting to reduce swelling.
Pain relief: Ibuprofen or naproxen to reduce pain and inflammation
Ottawa Ankle Rules (When X-rays Are Needed)
Get X-rays if you have:
- • Bone tenderness at posterior edge or tip of lateral malleolus (outside bump)
- • Bone tenderness at posterior edge or tip of medial malleolus (inside bump)
- • Inability to bear weight immediately after injury AND in emergency department/office (cannot take 4 steps)
- • Age over 55 with significant ankle injury
These rules are 98-99% accurate for ruling out fractures when negative.
Treatment Options
Grade 1-2 Ankle Sprains
- • RICE protocol for first week
- • Ankle brace or lace-up support
- • Physical therapy for strengthening and proprioception
- • Gradual return to activity over 2-6 weeks
- • Balance exercises to prevent re-injury
Grade 3 Sprains or Fractures
- • Walking boot or cast for immobilization
- • No weight bearing for several weeks
- • Possible surgery for severe ligament tears or displaced fractures
- • Extended physical therapy (8-12 weeks)
- • Gradual transition to ankle brace
Chronic Ankle Instability
- • Aggressive physical therapy focusing on proprioception
- • Ankle bracing during sports/activities
- • Surgical ligament reconstruction if conservative care fails
Prevention Tips
- • Strengthen ankle muscles: Resistance band exercises, calf raises
- • Improve balance: Single-leg standing, wobble board exercises
- • Wear proper footwear: Good arch support, avoid worn-out shoes
- • Warm up before activity: Dynamic stretches, ankle circles
- • Tape or brace: For sports if history of sprains
- • Watch your footing: Be careful on uneven surfaces
- • Stretch regularly: Calf stretches to improve flexibility
Medical Review
Reviewed by: Ricardo Hamilton, MD
Last Updated: November 26, 2025
Sources: American Academy of Orthopaedic Surgeons, American College of Emergency Physicians, Ottawa Ankle Rules Validation Studies