Patient's Self-Treatment Guide

Keywords: treatment for ankle sprain, treatment of ankle sprain, ankle strain treatment, twisted ankle, ankle twist, ankle pain, ankle fracture, rolled ankle

Doctor’s Excuse Note – Written By Parents

“Please excuse Joyce from jim today.”

“My son is under the doctors care and should not take P.E.  Please execute him.”

“Please excuse Roland from P.E. for a few days.  He fell out of a tree and misplaced his hip.”

“Please excuse Gloria.  She has been sick and under the doctor.”

- taken from doctorjokes.net -

Introduction to Ankle Sprains

The most important thing about ankle injuries is to distinguish whether it is just a sprain (ligament injury), or is it a fracture, or a soft tissue tear.  Unfortunately, it may be hard for you to tell just by looking at it, so you should get a medical professional to take a look at any ankle injuries with the red flags below.  For a more extensive discussion on the types of ankle sprains and prognosis, please refer to Wikipedia.  Below is a discussion of self-treatment for your ankle sprains.

Red Flags for Ankle Sprains

If you have these symptoms, see your doctor or go to the Urgent Care for evaluation for need for immobilization with a splint or cast to prevent further injuries:

• ankle sprain with severe pain and swelling
• ankle sprain accompanied by a crack or pop sound
• ankle sprain resulting with inability to bear weight or walk on the foot

If you do not have any of the red flags, you may want to watch it a little bit first.  Keep in mind however that even mild ankle sprains can result in injuries to the ankle’s ligaments, resulting in a weakened ankle, so it’s best to avoid running and jumping for the next 2 weeks.  This is to prevent an repeat ankle sprain that may result in a more serious injury.  For this reason, you may need to get evaluated by a doctor anyways to get a note to excuse you from certain physical activities or excuse from sports participation until the ankle has healed.

Self-Treatment for Ankle Sprains

If you do not have any of the red flags and wish to treat your ankle sprain before getting a proper evaluation from a doctor first, stick to the tried and true R.I.C. E. therapy:

• R = Rest. No running or jumping, minimize walking.
• I = Ice. Apply Ice to the area for 20 minutes at a time, 3 times a day for the first 5 days to help reduce swelling and inflammation.
• C = Compression.  Apply an elastic ACE bandage (available at the pharmacy) to help apply compression to the swollen area to help reduce the swelling. An ankle brace can also be bought at the pharmacy without a prescription to provide better support for the ankle.
• E = Elevation.  Sit down or lie down and prop that foot up with some pillows to bring it above the level of your heart to allow gravity to pull the extra fluid from the injured area.  Sometimes pain from an ankle injury is due to the swelling and not a physical tear in the tissues

Medications at the Pharmacy for Ankle Sprains

Over the counter medications can be used to help reduce the pain and swelling over the ankle.  The top FDA approved anti-inflammatories that you can buy according to OTC Guide are below.  If cost is a consideration, you can buy the generic (in italics).  Always follow dosing directions on the bottle.

Advil, Motrin (ibuprofen): can be taken every 6 hours for pain and inflammation.  Precautions: consult your doctor before taking this if you have high blood pressure, a history of ulcers or bleeding disorders, are pregnant, had bariatric surgery.

Aleve (naproxen): longer lasting, can be taken twice a day for pain and inflammation. Precautions: consult your doctor before taking this if you have high blood pressure, a history of ulcers or bleeding disorders, are pregnant, had bariatric surgery.

Tylenol (acetaminophen): If you cannot take the above anti-flammatories, then take this to control the pain.  Tylenol does not treat inflammation, but may temporarily numb the pain.  This is safe to be taken in pregnancy. Precautions: consult your doctor before taking this medication if you have a history of liver problems.

There are other items you can buy at the pharmacy that can be used to self-treat your ankles sprains as well.  Always use as directed.

Elastic Bandages: ACE elastic bandages to provide compression and reduce swelling.  These come in the cheaper ones with the metal clips, or the more expensive ones with the velcros.  Either one should do fine.  If you use the metal clips, I still use tape to tape it down so that you don’t pop a clip without knowing and have it unraveled too early.  Wrap the ankle from the bottom of the heel to above the ankle, taking care not to make it too tight.  Your foot and toes should stay pink in color and not turn white, blue, or purple; if so, the wrap is on too tight and you will have to rewrap it looser.

Ankle Braces: Ankle braces to prevent a repeat injury on an already weakened ankle.  These come as an inexpensive fabric wrap by itself, or the more expensive brace with plastic side supports.  While the fabric only ones may help with compression, it does little to help prevent the ankle from twisting again should you accidentally pivot too forcefully.  I prefer the ankle braces with the side supports.  They’re worth the extra money to prevent another injury to an already weak ankle.

Crutches: Cruches should be used to aid in walking if you cannot bear weight on the foot.  You can usually get used crutches at a great discount at second hand stores like Good-Will.  Just be sure they fit you properly.  The height should be adjusted to leave a 2 inch gap between to the top of the crutch and your armpit. Not being able to bear weight on your foot is a RED FLAG, so you should pay your doctor a visit if you are using crutches.

When Should You See Your Doctor for Your Ankle Sprain?

If you have tried the above steps for self treatment and things are not progressively getting better after a few days, or if anything is getting worse, then you should see your doctor.  Signs to look out for:

• When you have any of the red flags above.
• When your pain has become severe.
• When your swelling or bruising got worse
• When you can no longer bear weight on the foot.  Don’t walk on it now, buy a pair of crutches and go to the doctor.

What Can Your Doctor Do for Your Ankle Sprain?

• Do x-rays of the ankle and foot to look for fractures.
• Give you a proper diagnosis and treatment plans.
• Determine if it is safe for you to take higher doses of anti-inflammatory medications, or give you even stronger pain medications.
• Splint or cast the foot/ankle if they find a fracture.
• Write a note to excuse you from certain activities from school/work if needed.
• Determine whether you need surgery or physical therapy and refer you to the specialist for it.

Danh H. Nguyen, M.D.
Patient’s Self Treatment Guide
“Written For Today’s Self-Empowered Patients”
Last Updated 07/12/2011

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