When does an ankle sprain heal?
Are you experiencing an ankle sprain or strain, or are you a physical therapy student with questions about healing time? How long will the swelling, pain, bruising, immobilization, rehabilitation with crutches, work and sports hiatus, and more last?
As a physical therapist, I can answer all of your frequently asked questions. Based on my experience and scientific studies published worldwide on the subject, you can rest assured for the rest of your recovery journey 🙂.
Did you know that ankle sprains account for 1/4 of all sports injuries (Palmer 2016)? This makes it a well-known and studied problem compared to others!
Last update: April 2023
Disclaimer: Amazon affiliate links
Twisted ankle, sprained ankle, torn ligament: do they have different recovery times?
Ankle sprains are classified into three groups based on their severity:
- Grade 1 sprains, also known as mild ankle sprains, are sometimes called a “twisted ankle” in everyday language. In this case, the ligament has only been stretched but not torn, or only a few fibers have been torn. It still functions as a stabilizer for the ankle.
- Grade 2 sprains, also known as moderate ankle sprains or of medium severity. The ligament is partially torn, across a portion of its width. It no longer properly stabilizes the ankle, and the bones are not held together as well by the ligament.
- Grade 3 sprains, also known as severe ankle sprains or a “bad sprain” in everyday language. The ankle ligament is completely torn across its entire width. In this case, the ligament’s attachment to the bone is also torn, which is why the term “avulsion fracture” is used to describe this type of sprain.
Regardless of which ligament is affected (internal or external), it doesn’t determine the “severity.” Although in theory, the fewer ligaments affected, the faster the recovery (Choi 2020), the data on this issue is sometimes contradictory (Pepper 2008).
We have limited empirical data on the evolution of pain, swelling, and hematoma after an ankle sprain. And even less data is available specifically for each grade of sprain. That’s why the information in this article is general and applies to ankle sprains of any severity.
One general rule, however, is that all other things being equal, grade 1 sprains will recover faster than grade 2 and 3 sprains, and grade 2 sprains will recover faster than grade 3 sprains.
But medical rules are like those of French grammar: there are always exceptions or variations based on different parameters that are not always easy to identify. For example, the evolution of pain is not related to the severity of the sprain!
Which ankle sprain is most common?
The most common type of ankle sprain is the grade 1 or mild sprain.
This is because the ligaments are only stretched and not torn.
It is usually caused by a sudden twist or turn of the foot while walking or running. Although it is the mildest form of ankle sprain, it can still cause pain, swelling, and tenderness around the ankle.
How do I know if my ankle sprain is Grade 1 or 2?
It’s not always easy to tell if an ankle sprain is Grade 1 or 2. Even by a healthcare professional!
However, the severity of the sprain doesn’t necessarily correlate with the length of recovery time.
Even if you know the grade of your ankle sprain, the treatment and recovery process will be similar!
Some signs that you may have a grade 1 sprain include mild pain, swelling, and tenderness around the ankle. You may also be able to put weight on the affected foot without much difficulty.
If you have a grade 2 sprain, you may experience moderate pain, swelling, and tenderness, and may have difficulty putting weight on the affected foot.
As you can see, there’s not much difference!
How long does swelling last after an ankle sprain?
Concerns about swelling after an ankle sprain are common. In fact, several hundred people read everey day the article I wrote on swelling after an ankle sprain.
Here are the main points on this topic:
- Swelling is caused by an accumulation of fluids in the various layers of tissue in the ankle. It is related to inflammation of the ligament and surrounding tissues.
This inflammation helps repair damaged tissues by bringing all the necessary substances to the injured area through fluids, thus promoting natural healing as quickly as possible.
- Generally, swelling is at its maximum in the first few days following the injury. However, it can remain relatively large even 2 or 3 months after an ankle sprain, even a grade 1 sprain.
This isolated sign should not be a cause for concern. The ankle will return to its usual size over the course of months or years, even after a severe sprain.
- It is not because an ankle is swollen that it will necessarily be difficult to walk or even to engage in sports activities. In fact, it’s counter-intuitive: people with the most ankle edema are still able to do as much as those with less or none at all.
How long is the bruised sprained ankle recovery time?
A hematoma is simply a collection of blood under the skin. When your ankle was destabilized, tiny blood vessels (capillaries) broke. This can even happen after a simple blood test: it’s not something serious in itself.
The hematoma is not directly visible. What is often seen after a sprain, however, is bruising, which can take on different colors like yellow, purple, red, or green. This is because the blood has left its vessels. And that’s often what people want to get rid of.
These different colors are related to the substances contained in hemoglobin, an element of the blood. When it stays in the blood vessels, it doesn’t color the skin. But when it comes out, it does.
Generally, the skin is first red, swollen, and sensitive. Then the colors become darker. Often, the bruise spreads, but this is not a sign of seriousness if it remains isolated.
Bruising and hematoma usually last for a shorter time than swelling. It can last from a few days to a few weeks, rarely a few months.
As with swelling, this is a “normal” reaction due to the minor physical trauma you experienced. It doesn’t mean you have a more severe sprain.
How long does pain last after an ankle sprain?
First, let me go over the causes of pain after a sprain before discussing their duration.
What causes the pain?
The ligament injury in your ankle creates a lot of tiny debris from the torn ligament fibers.
These fragments will then come into contact with various chemical substances, leading to a chemical reaction known as the inflammatory response (Basbaum 2009).
The inflammatory response leads to the production of new chemical compounds that activate specific sensors (nociceptors) in the ankle ligament. These sensors transmit the painful information to the brain via nerves.
This pain that occurs immediately after the ankle sprain is called acute pain. If the pain persists beyond a few months, it is called chronic pain (which is rare for a sprain).
The immediate pain after a sprain is normal and useful. It forces you to rest your ankle for a while, allowing your body to heal the ligament properly.
How long does ankle pain persist?
Available data on the duration of pain and ankle sprains indicate that (van Rijn 2008):
- Pain decreases rapidly in the first 2 weeks following the ankle sprain.
- Up to 2 out of 3 people will have no more pain after one year.
- Up to 9 out of 10 people will have no more pain after three years.
And remember: there is no link between the severity of the sprain and the duration of the pain. You can have a stage 3 sprain and still be one of the people who have almost no pain after 2 weeks 🦾!
The ankle sprain pain decreases rapidly within the first 2 weeks, and up to 2 out of 3 people have no more pain after a maximum of one year.
What does persistent pain indicate?
Based on current scientific knowledge, it is believed that it takes between 6 weeks and 3 months for a ligament to fully heal (Hubbard 2008). Therefore, persistent pain for 3 months can at least be explained by this reason.
After this 3-month period, there are over a dozen reasons why ankle sprain pain may persist. These causes can be classified into two categories:
- Local causes: one or more anatomical abnormalities have developed in your ankle, in addition to the initial ligament injury. The list of these abnormalities is long (cartilage injury, bone spurs, tenosynovitis, nerve injury, etc.). Determining the precise cause of the pain can sometimes be difficult and may not necessarily provide more specific treatment options than symptom treatments.
- Neurological causes: your nervous system has become dysfunctional in how it manages pain.
How long is immobilization (splint, cast) needed after an ankle sprain?
It all depends on the severity of the ankle sprain and whether it is a first episode or not. It also depends on your “profile”:
- do you want to resume activity as quickly as possible, even if it means taking a little more “risk”,
- or do you prefer to play it safe, even if it means waiting longer than necessary?
The role of physiotherapists and doctors is precisely to accompany you in this process of reflection: there is no minimum immobilization period that suits everyone.
For grade 1 ankle sprains, immobilization is primarily for pain relief. It is generally done with an aircast-type splint/brace (or even without anything). It is removed after a few days, at most a few weeks.
The immobilization of grade 2 sprains has two objectives:
- to relieve pain;
- to encourage ankle stability by providing a small proprioceptive reminder. By feeling that there is something on the foot, we are more cautious, even if the aircast-type splints (or other brands, I do not recommend one brand over another) do not completely stabilize the ankle. Unlike walking boots (see below).
The splint or walking boot (see on Amazon) is again kept for a few days, at most a few weeks.
Generally, it is prescribed by the emergency medical team or the doctor you saw for the sprain. It can be purchased at a medical equipment store, pharmacy (often by order), or online.
In France 🇫🇷 : It is partially reimbursed by social security and health insurance companies, up to a few tens of euros depending on the model. Provided you have a prescription from a physiotherapist or doctor. To be reimbursed online, you need to send your prescription to the seller, who will send you a claim form. Make sure to check with them beforehand if they offer this service.
A cast is sometimes used for grade 3 sprains. It will be worn for 3 to 6 weeks, after a follow-up X-ray. As a transitional measure, a brace or orthopedic walking boot (see on Amazon) may be suggested.
|Grade of sprain||Immobilization period||Type of immobilization|
|1 or 2||Few days to 3-4 weeks, rarely 6 weeks||Brace|
|3||3 to 6 weeks, rarely more||Brace or cast|
Immobilization after sprained ankle often lasts only a few days / 2 weeks for a grade 1 sprain; 2-3 weeks for a grade 2 sprain; 3 to 6 weeks for a grade 3 sprain.
Is it OK to walk on a sprained ankle?
Yes, it’s possible to walk on a sprained ankle. But you’ll need to adapt your walking style (using crutches, limiting your walking distance, and gradually increasing your activity level).
Walking on a sprained ankle won’t necessarily worsen the injury, as long as you gradually increase your activity level.
The main risk is twisting your ankle again and aggravating the instability, but this can be minimized by avoiding uneven terrain and running at the beginning, and being careful and attentive when walking.
How long are crutches needed?
For stage 1 and 2 ankle sprains, recovery takes a few weeks. Walking is possible from the first day with crutches, and the crutches are usually abandoned after a few days, depending on the pain and stability felt.
Running can be resumed as early as 3 weeks after the sprain, but in a very gradual and controlled manner.
For stage 3 ankle sprains, walking with crutches is possible on the same day, but it will initially be more difficult to put a lot of weight on the foot.
Gradual resumption of physical activities other than walking is possible after these 6 weeks. Again, the resumption should be very gradual and controlled. Crutches are gradually abandoned after a few weeks (often 2/3, rarely 6/8 weeks).
See my more complete article on walking with or without crutches with an ankle sprain (coming soon in english).
|Sprain stage||Crutches duration|
|1 or 2||A few days to 3/4 weeks|
|3||3 to 6 weeks, rarely more|
After ankle sprain or strain, crutches are used for a few days to a few weeks.
When can I go back to work after ankle sprain?
The length of time off work will mainly depend on your job: does it require a lot of walking or standing? Some people may not need to take time off, while others may require a few days or even weeks off.
You can discuss this with your doctor, physiotherapist, and a representative from your workplace. (In France, physiotherapists cannot prescribe time off work, but they can provide letters to support a decision.)
In France, the National Health Insurance and the High Authority of Health do provide recommendations on the duration of time off work for doctors. The indicative timeframes range from 0 to 21 days.
The typical length of time off work for an ankle sprain is three weeks at most.
How long should I stay off a sprained ankle?
Here’s a table summarizing typical timeframes before returning to various activities after sprained ankle:
|Activity||Length of time|
|You can drive again||A few days to a few weeks|
|You can resume cycling||1 week to 6 weeks|
|You can gradually return to walking on uneven terrain||A few days or weeks|
|You can gradually return to running||A few weeks|
|You can resume other sports activities||1 to 6 months depending on the activity and its intensity|
|You are completely healed||A few weeks to a few months|
It can be frustrating not to have a more precise idea of the timeframe than “a few weeks”. However, it is difficult to be more specific without knowing:
- the type of sprain you have had,
- if it is a recurrence or not,
- what is the current state of your pain, discomfort, instability,
- what your level of activity was before.
In studies published on healing time after ankle sprain, some people considered themselves completely healed in 2 weeks… Others in 36 months! These are clearly two extremes (Pepper 2008).
The physical therapists or doctors who supervise your ankle sprain rehabilitation will take into account these different indicators to guide you through the gradual resumption of activities.
Also, know that you have an even greater chance of recovering better (Choi 2020) if:
- you have a grade 1 sprain (however, this contradicts a 2008 systematic review that concluded that ligament rupture does not increase the risk of poorer or longer recovery (Pepper 2008));
- your BMI is between 18 and 25;
- you are young.
On the other hand, your sex, your level of previous activity, and the job you do do not appear to affect your recovery.
Be optimistic: the vast majority of people resume their activities after an ankle sprain.
Whats helps a sprained ankle heal faster ?
There’s no medication, manual therapy, or miracle technique that can accelerate the healing of your ligament🙂.
The best advice I can give you is to stay as active as possible while respecting:
- Pain: You can do things if the pain is bearable.
- Progression: Don’t try to go for a run three days after your ankle sprain, especially if you haven’t put your foot on the ground for three days! You should gradually start walking indoors and outdoors (with or without crutches), gradually increasing the distances, durations, and intensity.
When it’s not too painful and you don’t feel unstable, then you can gradually start running on flat and sandy terrain.
Don’t feel guilty if you don’t follow the prescribed physiotherapy sessions because you feel like you’re doing fine, or if you’re anxious because you can’t get an appointment: everything should be okay!
You can already find an astronomical amount of videos and articles on the internet proposing exercises for ankle sprains. Here’s a simple infographic that gives an idea of exercises, among an infinite number of possibilities.
Many variations are possible, but in my opinion, it’s better to gradually resume your daily activities!
If you have a particular limitation, then you’ll need to find targeted and personalized exercises. Time will also do its job, no matter what you do!
THE BOTTOM LINE
If you’re dealing with a sprained ankle, you might be wondering how long it’s going to take to heal. Well, the recovery time can vary depending on the severity of the injury. Mild and moderate sprains might take a few days to a week to heal, while more severe sprains could take several weeks or even months.
You’ve reached the end of this article on healing time after an ankle sprain. I hope I have answered your main questions.
If you have any more, feel free to leave them in the comments, and I will answer them as best I can. I wish you a speedy recovery and a return to your activities 🙂 !
If you feel the need to learn more about the recovery period after a sprained ankle, I wrote this guide in eBook format:
You may also like:
- How long does it typically take for swelling to go down after an ankle sprain?
- How Long Does it Last to Walk after Rolled Ankle?
- Managing chronic pain after a twisted ankle
Pain: Basbaum, A. I., Bautista, D. M., Scherrer, G., & Julius, D. (2009). Cellular and molecular mechanisms of pain. Cell, 139(2), 267–284
Pepper 2008. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331.e6
Recovery time : Sharma GK, Dhillon MS, Dhatt SS. The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation. Foot (Edinb). 2016 Mar;26:48-52. doi: 10.1016/j.foot.2015.12.001. Epub 2015 Dec 13. PMID: 26895255.
Gribble PA, Kleis RE, Simon JE, Vela LI, Thomas AC. Differences in health-related quality of life among patients after ankle injury. Front Sports Act Living. 2022 Aug 3;4:909921. doi: 10.3389/fspor.2022.909921. PMID: 35992155; PMCID: PMC9382240.
Choi WS, Cho JH, Lee DH, Chung JY, Lim SM, Park YU. Prognostic factors of acute ankle sprain: Need for ultrasonography to predict prognosis. J Orthop Sci. 2020 Mar;25(2):303-309. doi: 10.1016/j.jos.2019.04.012. Epub 2019 Jun 7. PMID: 31151752.
Sport : Steinberg N, Adams R, Ayalon M, Dotan N, Bretter S, Waddington G. Recent Ankle Injury, Sport Participation Level, and Tests of Proprioception. J Sport Rehabil. 2019 Nov 1;28(8):824-830. doi: 10.1123/jsr.2018-0164. PMID: 30300059.
Swelling : Pugia ML, Middel CJ, Seward SW, Pollock JL, Hall RC, Lowe L, Mahony L, Henderson NE. Comparison of acute swelling and function in subjects with lateral ankle injury. J Orthop Sports Phys Ther. 2001 Jul;31(7):384-8. doi: 10.2519/jospt.2001.31.7.384. PMID: 11451309.
Hubbard -Turner, Tricia & Hicks-Little, Charlie. (2008). Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach. Journal of athletic training. 43. 523-9.
Badekas, T., Takvorian, M., & Souras, N. (2013). Treatment principles for osteochondral lesions in foot and ankle. International orthopaedics, 37(9), 1697–1706
Return to work after ankle sprain. Ameli.fr
Epidemiology. Palmer-Green DS, Batt ME, Scammell BE. Simple advice for a simple ankle sprain? The not so benign ankle injury. Osteoarthritis Cartilage. 2016 Jun;24(6):947-8. doi: 10.1016/j.joca.2015.12.019. Epub 2016 Jan 8. PMID: 26778532.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.