Sprained ankle treatment: grades, recovery time and when to see a specialist

Grades of sprained ankle: 1, 2 and 3

The ankle is one of the most stable, but complex joints in the body, held together by very strong ligaments designed to control and stabilise movement. When you injure those ligaments, the ankle can become unstable.

Ankle sprains are graded from 1 to 3, with Grade 1 being mild and Grade 3 being severe. In Grade 1 injuries, only part of the ligament is stretched, and these typically heal with a couple of days’ rest and relaxation. Grade 3 injuries are where there is a complete tear of all the fibres of the ligaments, or more commonly the ligaments pull away from the bone. These can be very swollen and bruised and take six weeks or longer to calm down. And a grade 3 ligament tear or twisted ligament may not heal on its own - “If you try and move a serious ankle injury too early," 

Mr Goldberg warns, "the ligaments can heal stretched or maybe never heal at all. This can cause long term problems and may even require surgery.”

What to do if you’ve rolled your ankle

No matter what grade of injury, Mr Goldberg explains the best initial treatment is to take the weight off your feet and apply the ‘RICE’ protocol straight away. "Rest, Ice, Compression and Elevation really are the best first response for most ankle injuries," he says. 

"In a Grade 3 injury which is very swollen and bruised, follow the ‘PRICE’ protocol, adding ‘Protect’.  You must limit movement, so the ligaments have a chance to heal in the right place. In these situations, I recommend a support ankle boot or an ankle brace.”

Sprained ankle recovery time by grade

Recovery time for a sprained ankle varies by grade. 

• Grade 1 sprains mostly resolve within 1-2 weeks
• Grade 2 injuries typically take 3-6 weeks
• Grade 3 sprains may take 3-4 months or longer to recover.

Once the swelling is reduced, probably after a few days for a mild injury, Mr Goldberg recommends some simple movements and weight-bearing exercises. More serious injuries may take a lot longer for the swelling to subside. This is where physiotherapy is helpful to work on the ‘dynamic stabilisers’, encouraging muscles and tendons to take over from damaged ligaments and restore function. If initial treatment was swift, most patients can make a full recovery.

"The problem comes when a Grade 3 ankle injury is missed, as these patients can go on having recurrent injuries over the years and eventually may even wear away the joint cartilage, with early-onset arthritis".

When surgery is the best option

If sprained ankle pain gets worse and instability persists after initial treatment, then you can choose to see a specialist. Mr Goldberg is fortunate to work with the network of HCA UK’s Urgent Care Centres. "Our multidisciplinary team all work together to scan and diagnose these patients as quickly as possible, so we can advise whether ankle braces or crutches are needed or even whether or not the patients may benefit from surgery".

"Surgery is rarely the first-line treatment for most ankle sprains" says Mr Goldberg. He continues, "the cases I tend to operate on early are either the really severe Grade 3 injuries in an elite athlete and those who plays sports regularly where rapid restoration of full function is essential, or those who had poor initial treatment and where recurrent sprains are now affecting their quality of life".

He reiterates that early diagnosis is key. "In a badly treated Grade 3 injury, the ligaments have healed stretched or not at all, and these patients can often run for miles in a straight line without issue, but if they try and cut or thrust at speed, they find their ankle unreliable. I would tend to recommend surgery in those cases".

Mr Goldberg performs different surgical interventions depending on the extent of damage, including:

1. Keyhole surgery (arthroscopy), an exploratory operation to check the condition of your ankle, and deal with scar tissue and damaged cartilage
2. A ligament reconstruction, sometimes called a Broström-Gould operation, to repair and reconstruct overstretched or torn ligaments and restore full function
3. His pioneering and specialised technique to restore function in severe ankle sprains even after failed surgery elsewhere.

Should I go to A&E for a sprained ankle?

When people go to A&E and are told their ankle is not broken, they feel relieved. However, a severe ankle sprain can, in some cases, be worse than a broken bone, as these injuries are often much more problematic than the bones themselves. 

If your ankle is bruised and swollen and you think you have a Grade 3 ankle sprain, you can been seen quickly in one of HCA UK’s walk-in Urgent Care Centres, and if necessary, given immediate ankle support and an MRI scan to see the extent of any soft tissue damage not seen on X-rays. In the case of severe injury, it could be your quickest route to a full recovery.