Rolled Ankle Heard Pop but I Can Walk: Can Make it Worse?

You have just rolled your ankle and have questions about whether you are allowed to walk or not, the risks involved with or without crutches, and when you will be able to walk normally again?

As a physical therapist, I will answer all of these questions regarding walking after twisting or spraining your ankle.

Whether your sprain is classified as a grade 1, 2, or 3 (mild, moderate, or severe) and whether it affects the inner or outer ligament, it is often difficult to determine the exact ligament that is affected and the severity of the sprain. However, there is no need to panic as I will provide you with some general guidelines.

To answer these questions, I rely on:

• My professional experience as a physical therapist
• Extensive research in published studies on ankle sprain recovery from medical journals worldwide. All the sources I refer to are listed at the end of this article.

The approach may vary depending on the individual and the healthcare professionals, such as physical therapists and physicians, who are directly involved in your care!

You heard “Pop!”: Why and Is it sure that it is a sprained ankle?

If you heard a “pop” sound at the moment of injury, it can be indicative of a sprained ankle, but it is not a definitive confirmation.

A popping sound can occur when the ligaments in the ankle stretch or tear. However, other injuries, such as fractures or tendon injuries, can also produce a similar sound.

Sometimes an x-ray is done to make sure it’s not an ankle fracture. But we only do an x-ray if there are other symptoms than the “pop”.

Here are the symptoms:

1. Pain in the malleolar zone (the bony protuberances on either side of the ankle)
2. AND :
   • the inability to bear weight immediately after the injury and in the emergency department for four steps, OR
   • bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
   • bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.
3. OR pain in the midfoot zone (the area of the foot between the ankle and the toes)
4. AND:
   • the inability to bear weight immediately after the injury and in the emergency department for four steps ,OR
   • bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
   • bone tenderness at the navicular bone (for foot injuries).

If any of these criteria are met, then an X-ray of the ankle is necessary to rule out a fracture. If none of the criteria are met, then an X-ray is usually not needed.

When is walking “prohibited”?

Walking may be prohibited or not recommended for you if:

• You have a grade 3 ankle sprain (severe sprain) with an associated bone avulsion seen on the X-ray. The medical team treating you has opted for immobilization with a cast or walking boot. Or a simple brace, but without allowing weight-bearing. Note that some people are allowed to walk even with a bone avulsion.
• You have a fracture that does not allow weight-bearing on that leg, either at the ankle or another part of the lower limb, on the same side as the sprain.

Normally, the doctor you saw (in a clinic, at the emergency room, etc.) will have verbally and in writing informed you that walking is not recommended for you. Here are some possible statements or instructions that indicate walking is not possible:

• “Non-weight-bearing” for 2 weeks / 1 month / 2 months.
• “No weight-bearing allowed.“
• “Contact only” (this means you are allowed to place the foot on the ground, but with minimal weight-bearing).

What about hopping or walking on one leg?

Of course, hopping or walking on one leg is NEVER prohibited for anyone. Even if it says “non-weight-bearing” on your discharge papers, you always have the option to move by walking, using the other leg and crutches or a walker for support.

Unless, of course, you have other fractures or issues that prevent you from bearing weight on that leg. But in that case, it would not be due to the sprain!

Did the healthcare professionals who diagnosed your sprain not provide any information about whether walking is allowed or not? And did they not write anything about it? In that case, you can consider that walking is permitted for you. However, you should adjust the intensity and manner of walking according to your pain level and ankle stability.

I sprained my ankle but I can still walk

You rolled your ankle, but you can walk relatively normally?

That doesn’t necessarily mean you don’t have an ankle sprain.

However, in my opinion, it may not be necessary to undergo further examinations if:

• You’re not particularly worried.
• It has happened to you before without any specific cause, and it resolved on its own.
• You feel that it’s getting better over hours and days.
• You don’t have any sensations of instability or significant pain while walking.

Of course, you can read this blog post to form a more informed opinion on whether it’s necessary or not, in your case, to pursue further investigations regarding the specific injury you have experienced.

Can walking on a sprained ankle make it worse or painful?

Of course, there is no such thing as zero risk. Yes, it is possible to twist your ankle again while walking during the recovery phase. However, that risk will always exist, even if you wait 3 months before walking again.

Moreover, there are risks involved in not walking as well! Muscle loss, poor blood circulation, impaired digestion, general physical deconditioning… the list goes on.

In my experience, the risk of worsening the sprain or experiencing a recurrence doesn’t typically occur during the phase of hesitating to walk. It is more likely to happen later when you resume physical activity!

Three years after an ankle sprain, 34% of people report experiencing at least one new sprain (Source: van Rijn 2008).

Given that you likely have pain, swelling, and apprehension due to the injury, you will naturally be more cautious. The walking boot, brace/orthosis, and crutches that you will likely use will also increase your attentiveness and mindfulness while walking.

By adapting your walking technique, everything will be fine!

And of course, the idea is not to immediately resume walking exactly as you did before the incident, right after leaving the emergency room or medical office! You will simply need to gradually reintroduce walking, adjusting it according to any potential pain.

By resuming walking in an appropriate and gradual manner, the risk of recurrent sprain or increased pain is minimal.

Being immobilized is generally less favorable than walking

How do people with lateral ankle ligament sprains fare:

• with 4 weeks of immobilization and limited walking,
• compared to people without walking restrictions or immobilization?

People without immobilization generally experience less pain, have better ankle flexibility and strength, and achieve better results on tests that assess their functional abilities.

Even in the case of a severe grade 3 sprain, some recommend not exceeding 10 days of strict immobilization.

Source: Matherne 2019

If you were not prescribed an Aircast or walking boot (as mentioned below), it is likely a good thing! If you were prescribed one, you can discuss with your physiotherapist the relevance and duration of its use in your specific case.

When is it truly forbidden to put weight on the foot?

As I mentioned at the beginning of this blog post, it is quite rare to be completely prohibited from bearing weight on the foot after an ankle sprain. This may occur in the following situations:

1. Severe grade 3 ankle sprain with associated bone avulsion or fracture. If your doctor determines that the fracture is unstable or displaced, they may immobilize the ankle with a cast or prohibit weight-bearing. However, in some cases, weight-bearing may still be allowed even with a bone avulsion.
2. If you have another issue affecting the same leg, such as an ankle fracture or tibial plateau fracture, which requires non-weight-bearing to facilitate proper healing.

It is unlikely that you would overlook a complete restriction on bearing weight on the foot. The diagnosing physician or surgeon would have explicitly informed you and documented it in your discharge summary or operation report if you underwent surgery.

Is it better to walk with or without crutches?

It is better to walk with crutches, at least during the first few days. Why?

1. To alleviate and limit pain.
2. To regain confidence.
3. To gradually test the stability of your ankle.
4. To walk with minimal limping.

Crutches will help you reduce the weight-bearing on the ankle that has experienced stretched or torn ligaments in your ankle. You can find the walking technique that suits you best:

• Walking with an alternating pattern, similar to using hiking poles or cross-country skiing poles.
• Walking with a three-point gait, where both crutches are placed on the ground with the injured foot.

If using crutches feels too complicated, you can use a walker instead.

One crutch or two crutches?

It is preferable to use two crutches rather than just one.

Using only one crutch can cause more limping and inclination towards the side of the crutch.

If you choose to use only one crutch, place it on the opposite side of the sprained ankle to provide better support.

When can you stop using crutches?

The key is to do it gradually! Crutches are primarily used to alleviate pain, providing pain relief. Over the course of several days, you will notice the following signs:

• Reduced pain.
• Increased comfort and faster walking pace.
• Decreased reliance on crutches for support.

When you experience these improvements, it’s time to gradually reduce the use of crutches. Start by walking without them indoors, then gradually progress to walking outdoors, including longer walks. Begin on flat and stable terrain before gradually transitioning to more uneven terrain.

It is advisable to use crutches for a few days or weeks to avoid limping, alleviate pain, and provide some stability to the ankle after a sprain. Then, gradually discontinue their use as you feel better.

Is it better to walk with or without an ankle brace?

Firstly, wearing an ankle brace (also known as an orthosis or Aircast, see on Amazon) or using strapping or kinesiology tape for “immobilization” or “support” is not obligatory or essential, especially for grade 1 or 2 sprains. If the healthcare professionals you have consulted did not prescribe it, they may not have deemed it necessary for your situation.

There are different schools of thought on this matter: some tend to prescribe immobilization methods more often, while others do so less frequently. As the patient, you must navigate these different perspectives 🙂.

So, there are two approaches:

1. If you have been prescribed an ankle brace or strapping for immobilization, continue wearing it while walking.
2. If nothing has been prescribed to you, then you can do without it!

Whether you have an ankle brace or not, my previous advice regarding walking with or without crutches remains valid.

If you have been prescribed something to wear around the ankle, you can keep it on while walking for a few days or weeks.

What can be done to regain normal walking faster despite the sprain?

There are no tricks or miracle remedies to speed up the process of healing after a rolled ankle.

Your injured ligament needs time to heal. This healing time is non-negotiable and varies from person to person, regardless of what they do. It typically takes 3 to 6 weeks, with 6 weeks being more common in cases involving bone avulsion. Bones take longer to consolidate than soft tissues to heal, and ligaments are considered soft tissues.

The best way to regain your pre-injury abilities, including sports activities, is to gradually reintroduce activities. Adapt according to any pain experienced during and after the activity. Avoid rushing into exercises that cause ankle instability, such as balancing on one foot on an unstable platform.

You need to find the right balance based on pain levels and the sensation of stability in order to progress through the following steps:

1. Walking with crutches (with or without ankle brace or strapping).
2. Walking without any support, slowly on flat ground.
3. Walking on uneven terrain.
4. Running on flat ground.
5. Running on uneven terrain.

The role of physical therapists is to support you throughout this gradual recovery process, especially for those who need an external perspective.

Cryotherapy, ultrasound therapy, shockwave therapy, osteopathy, and other treatments will not accelerate the healing process or enable a faster return to sports. These methods may provide a sense of reassurance and temporary pain relief for some individuals, but they do not significantly speed up tissue healing compared to those who do not use them.

🪄 There is no miracle remedy to walk faster. It is essential to respect the healing time of the tissues and gradually reintroduce activities.

When can one walk normally again after an ankle sprain?

The resumption of walking “as before” will depend on several factors:

• The severity of your initial sprain.
• Your own assessment of the risk involved.
• Your symptoms: pain, discomfort while walking, a sensation of instability.
• Your history: Have you had sprains before?
• Your age and body mass index (BMI).
• Your goals: Do you have a competition coming up?
• Any other existing health issues.

Considering these factors, it is clear that not everyone will resume walking at the same time.

It’s also important to note that the risk of a subsequent sprain is doubled for at least one year after the initial injury (Palmer 2016).

What I observe in my patients is as follows:

• Most people begin walking with crutches on the same day, at least indoors.
• Walking outdoors with crutches is resumed in the following days.
• After a few days or a maximum of 2-3 weeks (for grade 1 or 2 sprains), crutches are no longer needed. It may take 3 to 6 weeks for grade 3 sprains.
• In published studies on the subject, some individuals consider themselves fully recovered in 2 weeks, while others take up to 36 months. We are all different, including in our recovery from a sprain.

Source: van Rijn 2008.

⏱️ Normal walking is typically regained within a few weeks after an ankle sprain, or a few months in the case of a severe sprain.

How to walk properly after a sprain?

If you approach things progressively and make necessary adaptations:

• Adjust the speed of your walking.
• Modify the duration of your walking sessions.
• Increase the frequency of your walks.

By listening to your body and respecting any pain or discomfort (such as using crutches for a bit longer), things will naturally improve over time!

You can slow down your walking pace to try to walk without limping. Shorten your strides and relax your shoulders. With time, this will become more natural.

Your physical therapists and other healthcare or sports professionals are also available to provide you with personalized advice if needed.