If you just twisted your ankle, the first thing to do is stop what you’re doing and take weight off it. Most twisted ankles are sprains, meaning one or more ligaments got stretched or torn. How you treat it in the first 48 hours has a real impact on how quickly you recover. Here’s what to do right now and in the days ahead.
First 48 Hours: Protect It and Reduce Swelling
The standard approach for a fresh ankle sprain follows five steps, sometimes called the POLICE method: protection, optimal loading, ice, compression, and elevation.
Protection means keeping the ankle from moving in ways that could make things worse. If walking is painful, use crutches. A lace-up ankle brace or even a stiff shoe can help stabilize the joint while it’s most vulnerable.
Ice the ankle for 15 to 20 minutes every one to two hours during the first two days. Place a cloth or towel between the ice pack and your skin to avoid frostbite. This helps control pain and swelling early on.
Compression with an elastic bandage limits swelling and gives the ankle some support. Wrap it snugly but not so tight that your toes go numb or turn blue. If you notice tingling, loosen it.
Elevation means propping your ankle above heart level for 20 to 30 minutes, several times a day, especially in those first 48 hours. Lying on a couch with your foot on a stack of pillows works well. This helps drain excess fluid away from the injury.
Optimal loading is the part most people skip or misunderstand. Complete rest sounds logical, but ligaments actually heal better with some gentle movement. After the initial pain settles (usually a day or two), light, pain-free movement encourages the tissue to rebuild properly. That doesn’t mean going for a jog. It means small, controlled motions like the exercises described below.
How to Tell if It’s Mild, Moderate, or Severe
Ankle sprains fall into three grades based on how much damage the ligament sustained.
- Grade 1: The ligament is stretched or slightly torn. You’ll have mild tenderness, some swelling, and stiffness, but the ankle feels stable. Walking is usually possible with minimal pain.
- Grade 2: A partial tear. Pain, swelling, and bruising are more noticeable. The ankle feels somewhat unstable, the damaged area is tender to the touch, and walking hurts.
- Grade 3: A complete ligament tear. Swelling and bruising are severe, the ankle feels unstable or “gives out,” and putting weight on it is extremely painful or impossible.
Grade 1 sprains typically heal in one to three weeks with home care. Grade 2 sprains can take four to six weeks. Grade 3 sprains often need professional treatment and may take two to three months before the ankle is fully functional again.
When You Need an X-Ray
Not every twisted ankle needs imaging. Doctors use a set of criteria called the Ottawa Ankle Rules to decide whether an X-ray is worth doing. You likely need one if any of the following apply:
- You can’t bear any weight on the foot at all.
- You can’t take four steps, even with a limp.
- You have point tenderness when pressing on the bony bumps on either side of the ankle (the inner or outer ankle bone), or on the heel bone.
These signs suggest a possible fracture rather than just a sprain. If the ankle looks visibly deformed, is dislocated, or the foot is pointing in an unusual direction, go to an emergency department or urgent care right away. The same applies if you truly cannot get up and put any weight on the foot.
Pain Relief That Actually Helps
Over-the-counter pain relievers like ibuprofen or naproxen reduce both pain and inflammation, which makes them a good fit for the first several days when swelling is at its worst. Acetaminophen handles pain but doesn’t address inflammation, so it’s a reasonable alternative if you can’t take anti-inflammatory drugs due to stomach issues or other concerns.
Icing and elevation do a surprising amount of the work on their own. If you’re consistent about icing every couple of hours and keeping the ankle propped up, you may need less medication than you’d expect.
Early Exercises to Start Healing
Once the sharpest pain has passed, usually after two to three days, gentle range-of-motion exercises help the ligament heal in alignment and prevent the ankle from getting stiff. A simple and effective one: sit so your feet don’t touch the floor and use your big toe to “write” each letter of the alphabet in the air. This moves the ankle through its full range without putting weight on it. The American Academy of Orthopaedic Surgeons recommends doing two sets of this exercise daily.
Other early exercises include pointing your toes up and down (ankle pumps) and gently rotating the foot in circles. The key rule is that these movements should be uncomfortable but not sharp or painful. If something hurts, back off and try again the next day.
Rebuilding Strength and Balance
This is the stage most people skip, and it’s the reason so many sprained ankles get reinjured. When a ligament tears, even partially, it disrupts the nerve signals that help your brain sense where your ankle is in space. That’s called proprioception, and losing it makes the ankle more likely to roll again in the future.
Balance training is the most effective way to restore it. One well-studied approach uses short foot exercises, where you gently contract the muscles of your arch while keeping your toes flat. The progression looks like this: for the first four weeks, do these while sitting with your feet resting on an unstable surface like a balance pad. During weeks five through eight, progress to standing on two feet. Then move to single-leg standing. Aim for 5-second holds, 12 repetitions, three sets, three times a week.
Single-leg balance work on its own is also valuable. Try standing on the injured foot for 30 seconds at a time, first with your eyes open, then with your eyes closed. You’ll likely notice the injured side is significantly wobblier at first. That gap is exactly what you’re training to close.
Timeline for Getting Back to Normal
For a mild sprain, most people can walk comfortably within a week and return to exercise in two to three weeks. A moderate sprain takes longer: expect limited walking for the first one to two weeks, with a gradual return to full activity over four to six weeks. Severe sprains with complete ligament tears can sideline you for two to three months and sometimes require a walking boot or, in rare cases, surgery.
The biggest mistake people make is returning to sports or running too soon because the pain is gone. Pain fades before the ligament is fully healed and before your balance has recovered. If you can stand on one foot with your eyes closed for 30 seconds without wobbling, and you can hop on the injured ankle without pain, those are good signs you’re ready. If either one is still difficult, give it more time.