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Ankle Sprains & Ankle Pain

A rolled or twisted ankle is one of the most common injuries there is. Most sprains heal well with the right care — but a broken bone, a torn Achilles tendon or an ankle that keeps giving way needs a closer look.

What is an ankle sprain?

A sprain is an injury to the ligaments — the tough bands that hold the ankle bones together. It usually happens when the ankle rolls or twists: a misstep on uneven ground, a fall, or landing badly after a jump (Cleveland Clinic, AAOS OrthoInfo). Most sprains are on the outside of the ankle, when the foot rolls inward, and they are the number one reason athletes miss games or practice (AAOS OrthoInfo). Sports with quick turns and pivots, such as basketball, soccer and tennis, raise the risk, as do poor balance, very loose or very stiff ankles and high arches (Cleveland Clinic). The biggest risk factor of all is having sprained the ankle before (American Family Physician).

How bad is it? The three grades

Bruising from a moderate or severe sprain can take several days to show and usually fades over about two weeks (MedlinePlus). A severe sprain can feel just like a broken bone, which is why a bad injury needs to be checked (AAOS OrthoInfo).

Other common causes of ankle pain

  • Strains are injuries to a muscle or tendon (rather than a ligament), from a twist or pull, or from repeating the same movement over and over (NIAMS).
  • A broken ankle (fracture) causes immediate, severe pain, swelling, bruising and tenderness, and often makes it impossible to put any weight on the foot. Most need at least 6 weeks for early healing and 10–12 weeks to heal completely (AAOS OrthoInfo).
  • Achilles tendinitis is irritation of the big tendon at the back of the heel, usually from overuse. It causes morning pain and stiffness along the tendon and pain the day after exercise. Suddenly doing more exercise, tight calf muscles and a change of shoes can bring it on (AAOS OrthoInfo).
  • An Achilles tendon rupture is a tear of that tendon, often during a sudden push-off, a fall or a stop-and-start sport. Many people hear a snap or pop, feel sharp pain at the back of the ankle, and then struggle to walk, climb stairs or rise onto their toes (MedlinePlus).
  • Chronic ankle instability is an ankle that keeps giving way after a sprain. Most people recover fully from a sprain, but some go on to have ongoing instability (APTA/JOSPT guideline, 2021). Repeated sprains can lead to long-term pain, cartilage damage and arthritis, and not finishing rehabilitation is the most common reason it happens (AAOS OrthoInfo).
  • Ankle arthritis may be wear-and-tear (osteoarthritis), rheumatoid, or “post-traumatic” — arthritis that develops after an injury. An injured joint is about seven times more likely than an uninjured one to become arthritic (AAOS OrthoInfo).

Do I need an X-ray? The Ottawa ankle rules

Doctors use a simple, well-tested checklist called the Ottawa ankle rules to decide whether an injured ankle needs an X-ray. An X-ray is needed if there is pain around the ankle bones and either tenderness when the doctor presses along the back edge or tip of either ankle bone, or the person couldn’t take four steps right after the injury and still can’t at the visit (American Family Physician). A similar rule covers the middle of the foot. The rules have been checked in adults and in children as young as five, and are nearly 100 percent sensitive, so when none of the signs are present a fracture is very unlikely (American Family Physician). A review of 27 studies confirmed the rules are highly sensitive, and American Family Physician estimates they could cut the number of X-rays by 30–40 percent (American Family Physician). Physical therapy guidelines also say the rules should be used to decide when an X-ray is needed (APTA/JOSPT guideline). They are a tool for a trained clinician — if you’re unsure, get checked.

Get urgent care or go to the emergency room if:

While recovering from an Achilles tendon injury, call your provider right away if pain or swelling gets worse, the calf and foot swell, the leg or foot turns purple, you develop a fever, or you become short of breath (MedlinePlus).

See your doctor soon if pain doesn’t ease with ice, rest and pain relievers, the ankle hasn’t improved after 5–7 days, it keeps feeling weak or giving way, or the bruising is getting worse (MedlinePlus). Pain that lasts beyond 4–6 weeks may mean a chronic sprain (AAOS OrthoInfo).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Protecting the ankle with ice, compression and elevation at first, early weight-bearing in a brace or tape, then a structured exercise and balance program, often with a physical therapist. Short casting for some severe sprains; surgery is rare. Self-pay X-rays about $50–$300 at an imaging center and more at urgent care or an ER; physical therapy about $100–$200 a session at independent clinics; lace-up braces about $20–$60 and walking boots about $80–$200. Medicare Part B covers needed outpatient physical therapy (you pay 20% after the deductible). Mild sprains often heal in a week or two; severe ones can take 6–12 weeks or longer. Finishing rehab matters — skipping it is the most common cause of a chronically unstable ankle.
Chiropractic Hands-on mobilization or manipulation of the ankle and foot joints, usually combined with exercises. About $50–$200 a visit without insurance ($15–$75 with); first evaluations $100–$250. Physical therapy guidelines strongly support joint mobilization alongside exercise. Chiropractic-specific studies are small and show short-term pain relief, not proven long-term benefit. A fracture should be ruled out first.
Acupuncture Fine needles (sometimes with electrical stimulation or heat) at points around the ankle and elsewhere, usually alongside standard care. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. A Cochrane review rated the evidence for acute ankle sprains as very low quality and found no reliable support either way. A physical therapy guideline calls the evidence conflicting.
Herbal medicine Creams and ointments made from comfrey or arnica, rubbed on unbroken skin over the sore area. Cost estimate being researched. One trial found a comfrey ointment worked about as well as a diclofenac gel; arnica is unproven for sprains. Never take comfrey or arnica by mouth, never put comfrey on broken skin, and check for interactions.
Massage therapy Soft-tissue massage and gentle swelling-reducing (lymphatic drainage) techniques as part of rehab; foot-sole massage for chronic instability. Private therapists about $60–$120 for 45–60 minutes. Physical therapy guidelines include soft-tissue work alongside exercise. Research on massage on its own for ankle sprains is limited and mostly low quality.
MBHA Wellness Coach A step-by-step recovery plan, home balance and strengthening exercises, supportive footwear, healthy weight, and a safe, gradual return to sport. Cost estimate being researched. Balance training plus a brace after a first sprain has strong evidence for lowering the chance of spraining it again.

Approach 1 of 6

Conventional medicine (AMA)

Nearly all ordinary ankle sprains are treated without surgery — even a complete ligament tear can heal with the right protection and rehabilitation (AAOS OrthoInfo). Diagnosis is mostly made by examining the ankle; X-rays are used to rule out a broken bone, and an MRI is usually only needed if symptoms last beyond 6–8 weeks or another injury is suspected (AAOS OrthoInfo).

1. The first few days: protect, ice, compress, elevate

2. Bracing, taping or a cast?

Current guidance favors getting moving early, with weight-bearing as you can tolerate, rather than long periods of rest (American Family Physician). The U.S. physical therapy guideline strongly recommends a brace or tape with gradual return to weight-bearing; for more severe injuries, a semi-rigid brace or a below-knee cast may be used for up to 10 days (APTA/JOSPT guideline, 2021). A Dutch evidence-based guideline reached a similar conclusion: a short time immobilized can ease pain and swelling, but people do best with tape or a brace combined with an exercise program (clinical guideline, BJSM, 2018). Crutches may help for a few days when walking is painful (AAOS OrthoInfo, Cleveland Clinic).

3. Rehabilitation and balance training

Rehab usually moves through three phases: calming pain and swelling; restoring motion, strength and balance; then building up to straight-line running and finally the twisting and cutting moves of sport (AAOS OrthoInfo). Balance (“proprioception”) training is at the heart of it, because poor balance often leads to repeat sprains (AAOS OrthoInfo). Guidelines strongly recommend a structured exercise program — in the clinic and at home — covering range of motion, stretching, neuromuscular and balance training, and physical therapists may add hands-on joint and soft-tissue work alongside the exercise (APTA/JOSPT guideline). Supervised exercise is preferred over passive treatments (clinical guideline). The guideline advises against therapeutic ultrasound for acute ankle sprains (APTA/JOSPT guideline).

4. When surgery is considered

Surgery is rare. It may be considered when the ankle stays unstable and painful after months of proper rehab, for some “high” ankle sprains, or when there is other damage such as a cartilage injury or tendon tear. Options range from keyhole (arthroscopic) surgery to repairing or rebuilding the ligament (AAOS OrthoInfo, clinical guideline).

5. Other ankle problems

  • Fractures: a break that hasn’t moved out of place is often treated in a short leg cast or walking boot; displaced breaks and most with a dislocation need surgery with screws, plates or rods. Most people are back to normal activities within 3–4 months (AAOS OrthoInfo).
  • Achilles rupture: a partial tear rarely needs surgery and is usually treated in a splint or boot for about 6 weeks; a complete tear may need surgery. With physical therapy, most people return to normal activity in 4–6 months (MedlinePlus).
  • Achilles tendinitis: rest from high-impact activity, ice, calf stretching and supervised strengthening, softer or open-backed shoes and heel lifts come first. Cortisone injections are not recommended because they can cause the tendon to rupture; surgery is considered only if pain lasts after 6 months of nonsurgical care (AAOS OrthoInfo).
  • Arthritis: treatment starts with activity changes, low-impact exercise, weight loss, physical therapy, supportive shoes or braces and anti-inflammatory medicine. For disabling pain, options include fusing the joint or an ankle replacement (AAOS OrthoInfo).

What it costs

  • X-rays: self-pay prices for an X-ray run about $50–$300 at an independent imaging center, $250–$500+ at urgent care and $500–$1,500+ at an emergency room. One worked example for a mild ankle injury came to about $320: a $150 urgent-care exam, a $125 X-ray and a $45 brace (The Pricer).
  • Physical therapy: about $100–$200 a session at independent clinics and $200–$350+ at hospital-based ones; first evaluations about $150–$400+; insurance copays about $10–$75 a visit (estimates from Hinge Health, a digital physical therapy company). Medicare Part B covers medically necessary outpatient physical therapy with no yearly cap; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Braces: roughly $20–$60 for a lace-up brace, $30–$60 for an air-stirrup brace and $80–$200 for a walking boot (price guide from a Michigan podiatry practice). Prices change, and a clinician should choose the brace for a serious injury.

How well it works — what to expect

Most sprains heal well. A mild sprain usually takes a week or two (Cleveland Clinic); overall recovery ranges from about 2 weeks for minor sprains to 6–12 weeks for severe ones (AAOS OrthoInfo), and a complete tear can take several months (Cleveland Clinic). Doctors recommend a check-up 4–6 weeks after a significant sprain to look for lasting looseness (American Family Physician).

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Approach 2 of 6

Chiropractic

Chiropractors and other manual therapists use their hands to move stiff joints — either gentle, repeated movements (mobilization) or a quick, controlled thrust (manipulation or “adjustment”). After a sprain, the small joints of the ankle and foot can stay stiff, which limits how far the ankle bends.

What the research says

  • Physical therapy guideline: the 2021 U.S. guideline gives its strongest grade to hands-on joint and soft-tissue mobilization, done within pain-free movement alongside exercise, to reduce swelling, improve ankle motion and normalize walking after a sprain. For chronic ankle instability it also strongly supports joint mobilization and manipulation to improve ankle bending and balance — in the short term (APTA/JOSPT guideline, 2021). This guideline was written for physical therapists, not chiropractors, but covers the same kinds of techniques.
  • Chiropractic reviews: a 2012 review in a chiropractic journal rated the evidence for manipulative therapy in ankle inversion sprains as “fair” for short-term results and “limited” for the long term, and called for larger, better-designed trials (review, JMPT).
  • A small trial: in a 2015 study of 33 people with repeated sprains and an unstable ankle, adding six chiropractic manipulation sessions to a 4-week rehab program reduced pain and joint restrictions more than rehab alone in the short term, but did not improve function scores any more than rehab alone (randomized trial, JMPT).

In short: hands-on joint work can help an ankle move better in the short term, and works best as part of an exercise and balance program rather than on its own.

Safety

A severe sprain can look like a broken bone, so a fracture must be ruled out before anyone works on the ankle (AAOS OrthoInfo). If you have any of the warning signs above — can’t bear weight, deformity, numbness or a suspected Achilles tear — see a medical doctor first.

What it costs

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Approach 3 of 6

Acupuncture

Acupuncture is widely used for ankle sprains in some countries, including China and Korea, either alone or alongside standard care (Cochrane review). The research, unfortunately, doesn’t yet tell us much.

What the research says

  • Cochrane review (2014): 20 trials with 2,012 adults with acute ankle sprains, most of them done in China. All had a high risk of bias, and the reviewers rated the quality of evidence as very low. They concluded the evidence does not reliably support either the effectiveness or the safety of acupuncture for acute ankle sprains, and that larger, rigorous trials are needed (Cochrane review).
  • Physical therapy guideline (2021): rates the evidence on acupuncture for acute sprains as conflicting. For chronic ankle instability, it says clinicians may use dry needling (a related needling technique) of the muscles on the outside of the lower leg, together with balance training — a weak recommendation (APTA/JOSPT guideline).

In short: acupuncture isn’t a substitute for protecting the ankle and doing your rehab exercises. If you choose to try it, use it alongside them.

Safety

Complications have come from non-sterile needles and poor technique, and improperly done acupuncture can cause infections or other serious problems. Needles must be sterile and single-use, and most states license acupuncturists (NCCIH).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

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Approach 4 of 6

Herbal medicine

A few herbal creams are popular for sprains and bruises. The research is thin, and some of these plants are dangerous if swallowed. Herbs can’t heal a torn ligament or a broken bone.

Comfrey ointment (on the skin only)

In a 2005 trial of 164 people with an acute ankle sprain, a comfrey-root ointment rubbed on the ankle for about a week relieved tenderness at least as well as a diclofenac (anti-inflammatory) gel (trial, Phytomedicine). That is one single-blind study, so it can’t settle the question.

Comfrey safety. Comfrey contains pyrrolizidine alkaloids, which can damage the liver and have caused cancer in animal studies; in 2001 the FDA advised supplement makers to take comfrey products off the market (Memorial Sloan Kettering, NCCIH). Never take comfrey by mouth, never put it on broken or damaged skin, and don’t use it at all if you are pregnant or breastfeeding or have liver problems (RxList).

Arnica gel

Arnica is sold for sprains and bruising, but Memorial Sloan Kettering lists sprains only as a claimed use, without supporting studies; trials in other conditions are mixed (Memorial Sloan Kettering). The NIH notes some evidence that arnica or comfrey gels might help osteoarthritis — a different condition (NCCIH). Arnica taken by mouth has caused serious harm, it should be avoided in pregnancy and breastfeeding, and people allergic to ragweed, marigolds or other daisy-family plants may react to it. It may also add to the effect of blood thinners such as warfarin (Memorial Sloan Kettering).

“Natural painkillers” and other medicines

Some herbs act a bit like anti-inflammatory drugs or affect bleeding. Willow bark contains salicin, a relative of aspirin; taken with anti-inflammatories such as ibuprofen it may raise the risk of stomach and gut damage and bleeding, it may add to the effect of blood thinners, and it shouldn’t be given to children or anyone sensitive to aspirin (Memorial Sloan Kettering). Ginkgo taken with warfarin is linked to a higher risk of major bleeding (NCCIH).

Before you try any herbal product, remember that “natural” doesn’t mean safe, and tell your doctor or pharmacist about every supplement you use (NCCIH) — especially if you take anti-inflammatories, aspirin or a blood thinner, or are pregnant. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage after an ankle injury is usually part of a rehab program rather than a treatment on its own. The U.S. physical therapy guideline includes hands-on soft-tissue work and lymphatic drainage (a light massage technique), used to reduce swelling and done within pain-free movement and together with exercise, among its strongly recommended treatments after a sprain (APTA/JOSPT guideline, 2021).

What the research says

  • Chronic instability: a review cited in the guideline found that people with unstable ankles rated their ankles much better after hands-on treatments that included massage of the sole of the foot — measured before and after treatment, not against a comparison group (APTA/JOSPT guideline).
  • Tuina (Chinese therapeutic massage): a 2025 review of 13 small trials (984 people) with chronic ankle instability found better pain and ankle scores with tuina, but the overall quality of the trials was low, so better research is needed (systematic review, PLoS One).
  • Prevention: the NIH has funded research on whether massage can help people with ankle sprains avoid chronic ankle instability (NCCIH); the page doesn’t report results.

Safety

The risk of harm from massage appears to be low, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, often with vigorous deep-tissue work or in people at higher risk, such as older adults. Don’t use massage to put off seeing a doctor about a medical problem (NCCIH). MBHA suggests waiting until a fracture has been ruled out, and avoiding deep pressure on a freshly injured ankle.

What it costs

Private massage therapists charge about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach helps you follow through on the part of recovery that happens at home — which is most of it. Not finishing rehab is the most common reason a sprain turns into a chronically unstable ankle (AAOS OrthoInfo).

Your recovery plan

  • Pain and swelling often settle within about 48 hours; then you can start putting weight on the foot, a little at a time, stopping to rest if pain returns (MedlinePlus).
  • Keep gently moving within comfort — it helps prevent long-term stiffness (Cleveland Clinic).
  • A coach can help you track swelling and pain, keep your follow-up appointments, and notice warning signs that mean it’s time to call your provider.

Balance and strength exercises at home

The American Academy of Orthopaedic Surgeons publishes a foot and ankle conditioning program that includes calf stretches, calf raises, tracing the alphabet with your foot, picking up marbles and scrunching a towel with your toes, elastic-band ankle exercises and standing on one leg (AAOS OrthoInfo). Balance work can progress to standing on the injured foot with your eyes closed or using a balance board (AAOS OrthoInfo).

Footwear

A healthy weight

Body weight is one of the factors physical therapists look at because it can affect how a sprain recovers (APTA/JOSPT guideline). For ankle arthritis, losing weight reduces the stress on the joint, and low-impact exercise such as swimming or cycling is easier on it (AAOS OrthoInfo).

Getting back to sport — safely

Preventing the next sprain

A past sprain is the biggest risk factor for another one (American Family Physician). After a first sprain, guidelines strongly recommend wearing a brace for sport and doing a balance-focused exercise program to lower the chance of spraining it again (APTA/JOSPT guideline, clinical guideline). For people with risk factors, a brace can also lower the risk of a first sprain (APTA/JOSPT guideline). A brace on its own, though, isn’t enough to fix balance in an ankle that is already chronically unstable — that takes exercise (APTA/JOSPT guideline).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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