What do I do about a sprain or twisted ankle?

The first 48 hours for a minor sprain, what to avoid, and the signs that mean it needs looking at rather than resting.

Difficulty: beginner
Time: 20 min
Read: 2 min
Safety: warning

Short answer

Protect it, rest it, apply ice wrapped in a cloth for 15-20 minutes at a time, compress with a bandage and elevate it above heart level. Get it checked if you cannot bear weight, if it looks misshapen, or if it is not improving after a few days.

A sprain is a stretched or torn ligament, most often at the ankle. Minor ones settle with sensible early care, but distinguishing a sprain from a fracture is not something to do by feel — which is why the weight-bearing test matters.

Safety

Get medical attention if you cannot put any weight on it, if the joint looks misshapen, if there is numbness or the foot looks pale or cold, if there is severe pain or rapid heavy swelling, or if it is a child's injury. Those can indicate a fracture or a serious injury rather than a sprain. This guide covers immediate first aid for a minor sprain only and is not a substitute for medical assessment.

What you'll need

Ice or a bag of frozen peas
A cloth or tea towel
Elastic bandage (optional)
Cushions for elevation (optional)

Step by step

Stop and take the weight off it.Continuing on a fresh sprain worsens the damage and the swelling. Sit down before assessing anything.
Check whether it needs medical attention.Can you put any weight on it at all? Is the joint an odd shape? Is there numbness, or is the foot pale or cold? Any of those means get it seen rather than treated at home.
Apply ice, wrapped, for 15-20 minutes.Never directly on skin — wrap in a cloth. Repeat every two to three hours for the first day or two. It manages swelling and pain.
Compress with an elastic bandage.Firm but not tight. If the toes tingle, go numb or change colour, it is too tight — loosen it immediately.
Elevate it above heart level where you can.Cushions under the leg while lying down. This does more for swelling than most people expect.
Avoid heat, alcohol and massage early on.All increase blood flow and swelling in the first day or two. Heat is useful later, not now.
Start gentle movement once it settles.Complete immobilisation for a long period slows recovery. Gentle pain-free movement within a couple of days generally helps, but let pain be the limit.
Get it checked if it is not improving.A minor sprain should be noticeably better within a few days. Persistent inability to weight-bear or ongoing severe pain needs assessment.

Tips

A bag of frozen peas moulds to a joint better than an ice pack and is always in the freezer. Wrap it in a tea towel.
Do not test it by trying to walk it off. That is exactly how a moderate sprain becomes a long one.
Ankles that have been sprained once sprain again more easily. Balance work later is worth doing once it has healed.

Common mistakes

Applying heat in the first 48 hours — It increases blood flow and swelling when you are trying to limit both. Heat has a place later in recovery.
Bandaging too tightly — It restricts circulation. Tingling, numbness or colour change in the toes means loosen it straight away.

Questions people ask

How do I know if it is broken rather than sprained?

You cannot reliably tell at home. Inability to bear any weight, obvious deformity, numbness, or severe pain and swelling all point towards getting it assessed rather than treating it as a sprain.

How long does a sprain take to heal?

A minor one improves noticeably within days and settles over a couple of weeks. Anything not clearly improving after a few days should be looked at.