When does an ankle need checking straight away?

Go to an emergency department now if:

  • the ankle looks out of shape;
  • your foot is cold, pale or blue, or your foot or toes have gone numb.

See a doctor or physio the same day if:

  • you can't take four steps on the ankle, even with a limp;
  • it hurts to press on any of these bones:
    • the back edge or tip of the bony knob on either side of the ankle;
    • the outside edge of the foot, halfway along;
    • the bump on the inner side of the middle of the foot;
  • the pain is high up, between the two shin bones, rather than on the outside of the ankle.

Out of hours, go to an urgent care clinic or an emergency department. In Queensland you can also call 13 HEALTH (13 43 25 84) for advice.

The four-step check and the bone check are the Ottawa ankle rules, which a doctor or physio uses to decide whether you need an X-ray [1]. If you can take four steps and none of those bones is sore to press, a broken bone is very unlikely [2]. The last check is for a "high" sprain, which needs its own plan.

This article is written for people aged 16 and over. If your child has hurt their ankle, have it checked by a doctor or physio, because a child's growing bones can break where an adult's ankle would only sprain.

Most rolled ankles are simple sprains

If none of that applies, you most likely have an ordinary sprain of the ligaments on the outside of the ankle. For pain, swelling and getting the ankle working again, the research supports moving it early rather than keeping it still for long [3]. Walk on it as comfort allows, and keep the ankle moving gently. For pain relief, ask your pharmacist or GP what suits you.

When is it worth seeing a physio for a sprain?

  • You're still limping two weeks after the sprain, or the swelling isn't going down from one week to the next.
  • It's not the first time you've sprained that ankle, or it feels as if it gives way.
  • You play sport and want a plan for going back.
  • You're nervous about running, hopping or changing direction on it.

A sprain can leave the ankle with a weaker sense of position and slower muscle reactions, and these can make another sprain more likely [4]. A physio can test for them and plan the balance and control training that lowers the chance of another sprain [3].

What happens at a physio appointment for a sprained ankle?

I check the bones and the ligaments, and how far the ankle bends upwards. I test your balance on one leg against the other side, and if the ankle is ready I watch you walk, hop and land. A 2018 clinical guideline lists reduced ankle bend, poorer balance on one leg and a reduced sense of position among the things that raise the chance of a sprain, so those are what I look for [1].

Then we plan the steps back to your sport: what to work on each week, the checks before you return, and whether a brace makes sense for the season. Bracing has strong evidence for lowering the chance of another sprain [3].