Kids Health Info

Ankle sprains - acute

  • Ankle sprains are one of the most common injuries in children. Ankles are made up of three bones with ligaments (tough, stretchy tissue which hold the bones together). The ligaments help stop the ankle joint from moving around too much.

    Causes of ankle sprains

    Ankle sprains usually happen when there is a sudden movement or twist, and often when the foot rolls over. A sudden movement or twist can overstretch the ligaments, causing tears and bleeding (which shows as bruising and swelling) around the ankle joint. These movements are more likely to happen when a person is running, jumping or quickly changing direction in sports such as basketball, netball or football.

    Signs and symptoms

    Signs and symptoms of ankle sprains include:

    • Swelling: the ankle can swell in minutes or over several hours.  This is caused by soft tissue damage.
    • Pain around the outside part of the ankle joint.
    • Bruising: the ankle may become discoloured. If this happens, the bruising will show up within two to three days.


    Treatment is based on First Aid principles.  It should start immediately and continue for the next two to three days. Using the Rest, Ice, Compression, Elevation (RICE) strategy will help.


    Rest the injured area and avoid activities that cause a lot of pain. If your child is having difficulty walking, crutches should be used.


    Apply ice to the injured area for 10-15 minutes. Never place the ice directly on the skin because it can burn the skin.  You should always wrap the ice or icepack in a teatowel or a pillow case. Do this every two to four hours for two to three days, when your child is awake. An ice pack is best made using a plastic bag with some ice and water in it. This moulds better to the ankle joint area.


    Use a firm bandage that is not too tight and does not stop circulation or cause extra pain. The bandage should cover from just above the ankle right down to the foot. Do not cover the toes.


    Raise the ankle whenever possible to assist with reducing the swelling. For example, raise your child's injured leg and rest it on some pillows while they are watching TV, reading or resting.

    Pain relief

    Some children will need medicine to help with the pain. In most cases, paracetamol is enough. Anti-inflammatory medications may help, but these are not suitable for every child. Ask your health care professional for further advice. Always read and follow the instructions on the package for the appropriate dose of medication for your child.

    In the first two to three days AVOID:

    • Heat - this increases blood flow and makes the swelling worse.
    • Reinjury - protect the ankle joint from reinjury by keeping weight off it and moving carefully.
    • Massage - which promotes blood flow and makes the swelling worse.

    Ankle exercises

    Encourage your child to gently exercise and stretch the ankle joint. This should begin almost immediately to minimise stiffness. Start with exercise 1 and progress to exercise 4. Your child may have some mild pain at first.  If significant pain is experienced, further rest is required. Walking on the ankle should be encouraged after two to three days if the pain is bearable. Active movement will quicken the healing process.

    1. Ankle Alphabet

    Using the ankle and foot only, trace (in the air) the letters of the alphabet from A-Z.

    1. Foot circles

    Draw a circle in the air with the affected foot.

    Repeat this 10 times.

    1. Foot pushes

    Push the affected foot up and down 10 times.

    1. Calf Stretch (a)

    With the knee straight, use a towel to gently pull the foot towards the face until a stretch is felt in the calf.

    Hold this stretch for 30 seconds. Do this three times.

    OR (b) Assisted calf stretch
    Get someone to help you.  With the knee straight, and holding onto the foot, gently pull it towards the face. The child should feel a comfortable stretch in the calf.

    Hold for 30 seconds. Do this three times.

    Remember - Recovery can start very early after injury. Following the principles of RICE and ankle exercises can help reduce your child's pain and swelling a lot, making it easier for them to walk again.

    Preventing injury

    • Encourage your child to warm up before they exercise.
    • Wear supportive shoes appropriate to the sport.
    • Consider ankle braces or tape if your child has ongoing or recurrent problems.

    When to see a health professional

    If the pain from a sprained ankle that you have been managing at home has not improved after a few days, it is best to seek medical advice from your doctor or physiotherapist. Either practitioner can examine your child's ankle, order an x-ray if needed and provide a management plan for your child's injury.

    You can expect your child to fully recover from most ankle sprains in one to two weeks. The length of time depends on your child's age, general health and the severity of the injury.

    Key points to remember

    • Ankle sprains are a common injury in children.
    • The pain and swelling from an ankle sprain should improve within two to three days if the treatment guidelines are followed.
    • If your child is unable to put weight on the injured ankle and/or you are unable to control their pain, you should seek medical advice.
    • Most children recover fully from an ankle sprain.

    For more information

    • See your local doctor or health care professional.
    • Visit a physiotherapist.
    • Contact the Australian Physiotherapy Association
      T: (03) 9092 0888


    Developed by the RCH Dept of Emergency Medicine. First written May 2009. Updated May 2013.

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This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.