What to Do Right After an Ankle Injury: Immediate Care Tips for Fast Recovery

A sudden twist, a missed step, or a mid-game misstep—ankle sprains can catch anyone off guard. The key to bouncing back quickly is knowing exactly what to do in those first hours and days after the injury. Whether you’re an athlete benched unexpectedly or someone navigating an unlucky tumble, the steps you take immediately can set the tone for your recovery.

Let’s break it down: from quick fixes like RICE to long-term strategies like PEACE & LOVE, here’s your go-to guide for tackling an ankle sprain head-on.

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Step 1: Immediate Response – Why the First 24 Hours Matter

The first 24 hours after an ankle injury are make-or-break time. This is when your body’s inflammatory response kicks into high gear, causing swelling, pain, and sometimes a not-so-pretty bruise. While this reaction is normal (and even helpful), unmanaged inflammation can lead to complications like tissue damage or extended recovery times. That’s why what you do right away is so important.

Start by recognizing the signs: swelling, bruising, pain, and limited mobility. The goal in these early hours is simple: reduce swelling, manage pain, and protect the injury to prevent further damage. The quicker you take action, the smoother your recovery will be.

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Step 2: RICE vs. PEACE & LOVE – Choosing Your Recovery Path

For years, RICE (Rest, Ice, Compression, Elevation) was the gold standard for ankle sprains—and it’s still a solid approach for initial care. But today, many experts are leaning into a more holistic recovery framework: PEACE & LOVE. This method doesn’t just stop at early care; it paves the way for a long-term recovery plan that helps you regain full strength.

Here’s how they compare:

RICE (Rest, Ice, Compression, Elevation)

• Rest: Keep weight off your ankle to prevent further injury.
• Ice: Apply ice for 15-20 minutes every couple of hours to reduce swelling.
• Compression: Use a wrap or bandage for support and to manage swelling.
• Elevation: Keep your ankle raised above heart level to minimize fluid buildup.

PEACE & LOVE

• PEACE (Protect, Elevate, Avoid anti-inflammatory drugs, Compress, Educate):
  • Protect your ankle by avoiding weight-bearing activities.
  • Elevate to reduce swelling (hello, couch time!).
  • Avoid NSAIDs early on—let your body’s inflammation response do its healing magic.
  • Compress with a bandage for added support.
  • Educate yourself on recovery techniques.
• LOVE (Load, Optimism, Vascularization, Exercise):
  • Gradually reintroduce movement to stimulate healing.
  • Stay optimistic—your mindset plays a big role in your recovery.
  • Encourage blood flow with light, pain-free movement.
  • Start exercises to rebuild strength and flexibility.

While RICE is a great place to start, PEACE & LOVE shifts the focus toward active recovery and long-term resilience.

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Step 3: When to See a Doctor

Sometimes, a sprain needs more than at-home care. Here’s when to seek medical attention:

• You can’t bear weight on your ankle at all.
• Pain is intense and doesn’t ease after a few hours.
• Swelling gets worse or doesn’t go down after 72 hours.
• Discoloration or instability makes walking difficult.

Getting an X-ray or MRI can rule out serious issues like fractures or ligament tears, ensuring you’re on the right track for recovery.

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Step 4: The Days After – Moving Toward Recovery

Once the initial pain and swelling subside, it’s time to ease back into movement. But don’t rush it—this phase is all about balance. Too much rest can lead to stiffness, while pushing too hard can result in setbacks.

Start with these steps:

• Gentle Range-of-Motion Exercises: Move your ankle in all directions to keep it flexible.
• Light Weight-Bearing: Use crutches or a walking boot if needed, but aim to wean off them as soon as it’s safe.
• Strengthening: Begin simple exercises like towel scrunches, balancing on one foot, or resistance band work to rebuild stability.
• Listen to Your Body: Sharp pain is your sign to slow down.

Gradually transitioning from rest to activity is critical for avoiding re-injury and building long-term strength.

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Takeaway

An ankle sprain might feel like a major hurdle, but with the right care, you’ll be back on your feet in no time. Start strong with immediate care—whether you choose RICE or the more comprehensive PEACE & LOVE—and know when to call in a professional for help. Recovery is a process, but by taking it one step at a time, you’ll come back stronger than ever.

Stay proactive, stay patient, and above all, stay optimistic—your ankles have got this!

Dr. T

If you’ve ever experienced the discomfort and inconvenience of an ankle sprain, you’re not alone. In this blog, we will take a look at the complexity of ankle sprains, focusing particularly on the most common ligament involved.

Ankle Anatomy and Function:

Before we get into the specifics of ankle sprains, let’s take a moment to understand the anatomy of the ankle joint. The ankle is a complex structure composed of bones, ligaments, and tendons that work together to provide stability and support during movement. Ligaments, in particular, play a crucial role in maintaining the integrity of the ankle joint by connecting bones and preventing excessive motion.

Causes and Symptoms of Ankle Sprains:

Ankle sprains can occur as a result of various factors, including sudden twists, falls, or sports-related injuries. When the ankle is forced beyond its normal range of motion, ligaments can become stretched or torn, leading to pain, swelling, bruising, and difficulty bearing weight. These symptoms are often indicative of an ankle sprain and should be promptly evaluated and treated to prevent further complications.

Among the numerous ligaments in the ankle joint, one stands out as the primary culprit in most ankle sprains: the anterior talofibular ligament (ATFL). 

This ligament, located on the outer aspect of the ankle, is particularly susceptible to injury due to its position and function in stabilizing the ankle during movements. When the foot is forcefully inverted or turned inward, the ATFL is often the first to bear the brunt of the force, resulting in sprains and subsequent pain and discomfort.

Factors Contributing to ATFL Sprains:

Several factors can increase the risk of ATFL sprains, including

• previous ankle injuries
• inadequate footwear, and
• participation in high-impact activities.

Individuals with weak ankle muscles or poor proprioception may also be more prone to ankle sprains. Recognizing and addressing these risk factors is essential for preventing future injuries and promoting overall ankle health.

Treatment and Recovery:

If you’ve experienced an ankle sprain, timely treatment and proper management are key to a successful recovery. Initial treatment often involves a combination of PEACE & LOVE to reduce pain and swelling. In severe cases or those with persistent symptoms, medical evaluation and imaging studies may be necessary to rule out more significant injuries. Physical therapy and rehabilitation exercises are essential components of ankle sprain recovery, helping to restore strength, flexibility, and proprioception.

Preventing Ankle Sprains:

While ankle sprains can be challenging to avoid entirely, there are steps you can take to reduce your risk of injury.

• Wearing supportive footwear,
• warming up before physical activity,
• and practicing proper technique are effective strategies for preventing ankle sprains.

Additionally, incorporating strength and flexibility exercises into your routine can help improve ankle stability and resilience, reducing the likelihood of future injuries.

Ankle sprains are a common orthopedic injury that can significantly impact daily activities and quality of life. By understanding the anatomy of the ankle, recognizing the signs and symptoms of sprains, and addressing contributing factors, you can take proactive steps to protect your ankles and minimize your risk of injury. Remember, your health and well-being are our top priorities, and I am here to support you every step of the way on your journey to recovery!

Dr. T

Understanding the Heel Raise

The heel raise, also known as the calf raise, is a crucial exercise for both preventing and rehabilitating ankle sprains. This simple yet effective movement provides valuable insights and feedback essential for tailoring treatment strategies.

How to Perform a Heel Raise

Performing a heel raise is straightforward:

• Double Leg: Stand on both legs and rise up onto your toes, lifting your heels off the ground.
• Single Leg: Stand on one leg and rise up onto your toes, lifting your heel off the ground.

Variations and Adaptations

There are numerous variations of the heel raise to suit individual needs and goals. A quick search on YouTube will reveal options such as isometric holds, elevated surfaces, weight shifts, eccentric movements, resistance with therabands, toe extensions, ball squeezes, and more.

Avoiding Common Pitfalls

To get the most out of your heel raises and avoid injury, keep these tips in mind:

• Complete the full range of motion.
• Avoid bouncing or jerking movements.
• Do not perform the exercise if you are in pain.
• Keep your knees slightly bent and avoid arching your back excessively.
• Avoid wearing running or training shoes with high heels while performing this exercise.

Clinical Value of the Heel Raise

Incorporating the heel raise into clinical practice offers numerous benefits:

1. Assessment Tool: The heel raise is a valuable assessment tool for evaluating plantarflexion strength. Normative values provide benchmarks for comparison, helping identify strength deficits.
2. Determining Ankle Instability: Inability to perform a heel raise may indicate mechanical and functional ankle deficits, increasing the risk of injury.
3. Prevention Intervention: For those with a history of ankle sprains, the heel raise can help prevent future injuries by strengthening the calf muscles.
4. Post-Injury Rehabilitation: Gradually loading the ankle through heel raises aids in tissue repair and functional recovery after an ankle sprain.
5. Advanced Rehabilitation: As patients progress, advanced variations of the heel raise can be incorporated into rehabilitation programs, providing versatility and adaptability.

Exploring Advanced Variations

Advanced variations of the heel raise introduce complexity and challenge, beneficial for athletes and those needing advanced functional rehabilitation. These variations include:

• Increased time under tension
• Elevated platforms
• Added resistance
• Surface variations
• Multi-planar movements
• Plyometrics
• Sport-specific exercises

Unlock the full potential of the heel raise in sports medicine rehabilitation by incorporating advanced variations to strengthen ankle stability and function.

To challenge balance and proprioception:

• Ensure each leg receives equal attention.
• Perform on an unstable surface like a balance pad or Bosu ball to engage extra stabilizing muscles.

For added resistance:

• Use resistance bands or hold dumbbells,
• Gradually increase weight to build strength and endurance over time,
• Improve tendon resilience and muscle control with eccentric heel raises (slowly lowering the heels back to the ground) .

To target different aspects of the calf muscle:

• Point toes inward or outward to engage different muscle fibers.
• Focus on proper form.
• Maintain controlled movements to prevent injury and maximize benefits.

Integrating heel raises into a comprehensive rehabilitation program can significantly enhance an athlete’s performance and reduce the risk of future injuries. Consistency and progression are key, so regularly assess and adjust the difficulty of the exercises based on individual progress.

What are the OARs?

The Ottawa Ankle Rules (OARs) emerge as a pivotal clinical decision tool, introduced in 1992 and formally validated in 1995. In essence, they serve as a guide for determining the necessity of radiographs in individuals with traumatic ankle and foot injuries. Simply put, a positive result from the OARs warrants radiographs to rule out fractures, and conversely. In this blog post, we will explore the importance and use of the OARs, explaining how they streamline diagnosis and assist healthcare professionals such as yourself in decision-making.

The OARs are designed to help healthcare providers identify which patients require X-rays following an ankle or foot injury, ultimately reducing unnecessary imaging and associated costs. By following a structured set of criteria, clinicians can confidently assess the likelihood of a fracture based on the patient’s symptoms and physical examination findings.

Moreover, the implementation of the OARs can lead to more efficient patient care, as it allows for timely identification of fractures that require immediate intervention. By facilitating accurate and prompt diagnosis, these rules contribute to better outcomes for patients while also optimizing resource utilization within healthcare settings.

In the subsequent sections, we will explore why the OARs are needed, what continues to drive radiographs, alternative protocols and provide practical insights for you as the healthcare professional on incorporating this valuable tool into their clinical practice.

Why were/are they needed?

Lateral ankle sprains (LAS) reign as the most prevalent injuries encountered in the Emergency Department (ED), amassing a substantial medical cost of 2 billion annually. Pre-OARs era, a staggering 98% of ankle sprains presented in the ED underwent imaging, with 85% yielding negative results. Particularly in secondary care settings, where financial constraints may impede access to radiographs, the OARs present a cost-effective alternative. By effectively utilizing the OARs and reserving radiographs for positive cases, families can be spared unnecessary expenses and visits to the ED or doctor’s office.

What continues to drive the use of radiographs?

Despite the existence of the OARs, several factors persist in propelling the utilization of radiographs. These include parental concerns, stakeholder expectations, adherence to ED protocols, defensive medicine practices, patient satisfaction surveys, and the overarching fear of litigation. The influence of parental expectations and anxieties cannot be overstated.

Alternative protocols

While alternative protocols such as the tuning fork and Bernese Ankle Rules have been proposed, the Sonographic Ottawa Foot and Ankle Rules (SOFAR) warrant attention. SOFAR introduces the use of ultrasound (US) in cases where the OARs yield positive results. Although this approach offers certain advantages, it is not devoid of limitations, notably increased costs and dependence on operator proficiency. Studies have also indicated the potential for clinically significant fractures to be overlooked.

Missed fractures with OARs

Although the OARs have proven effective, isolated case reports highlight instances of clinically significant fractures being missed. Challenges in these cases include determining whether the OARs were appropriately applied, establishing clear definitions of clinically significant fractures, addressing implementation complexities, and ensuring consistency in application between different assessors.

Interesting fact

The journey of the OARs from inception to validation was not without contention. Despite their introduction in 1992, formal validation did not occur until 1995. Notably, during this period, a separate research study contested the efficacy of the OARs. However, this study encountered criticism for its small sample size and premature publication, as it was conducted prior to the refinement and validation of the OARs.

Practical Insights

Practical insights for you as the healthcare professional on incorporating this valuable tool into your clinical practice include conducting training sessions for all healthcare staff to ensure they are familiar with the OARs and understand how to apply them correctly; develop easy-to-follow protocols and checklists that can be readily accessed in the clinical setting to assist with decision-making; collaborate with other healthcare professionals to share knowledge and experiences, improving the overall implementation of the OARs; and encourage open communication and feedback amongst staff to address any challenges or concerns that may arise during the adoption of these rules.

Additionally, staying up-to-date on recent research and guidelines on ankle injuries can enhance the effectiveness of integrating the OARs into your daily practice. By promoting a culture of ongoing learning and improvement, you can enhance patient care and outcomes in managing ankle injuries.

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The OARs remain the cornerstone of clinical practice, serving as a reliable guide in the assessment of ankle and foot injuries. However, it is imperative to complement their use with sound clinical judgment, considering individual patient characteristics and circumstances.

By integrating the OARs with thoughtful clinical assessment, you can enhance the accuracy of diagnosing ankle and foot injuries. This approach not only ensures proper care and treatment for your patients but also promotes a more comprehensive understanding of each unique case. By valuing both evidence-based guidelines and individualized care, you can optimize patient outcomes and deliver high-quality patient care.

Dr. T