context: The ankle joint, which connects the foot with the lower leg, is injured often. An unnatural twisting motion can happen when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Such injuries to the ligaments or tendons of the ankle happen during athletic events, while running or walking, or even doing something as simple as getting out of bed. Ankle injuries can be painful and can make it hard to carry out your daily activities. Ligaments, which provide the connection between the bones of the ankle, are injured when more than normal stretching force is applied to them. This happens most commonly when the foot is turned inward or inverted. This kind of injury can happen in the following ways: Awkwardly planting the foot when running, stepping up or down, or during simple tasks such as getting out of bed Stepping on a surface that is irregular, such as stepping in a hole One player stepping on another during an athletic event ( A common example is a basketball player who goes up for a rebound and comes down on top of another player's foot. This can cause the rebounder's foot to roll inward.) When an ankle is injured with a sprain, tendon injury, or fracture, inflammation occurs. Blood vessels become "leaky" and allow fluid to ooze into the soft tissue surrounding the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well. Typical changes that happen with inflammation, include the following: Swelling because of increased fluid in the tissue: Sometimes the swelling is so severe that you can leave an indentation in the swollen area by pressing on it with your finger. Pain because the nerves are more sensitive: The joint hurts and may throb. You can often make the pain worse by pressing on the sore area, by moving the foot in certain directions (depending upon which ligament is involved), or by walking or standing. Redness and warmth caused by increased blood flow to the area. Usually, an ankle sprain itself does not call for a trip to the doctor. The problem is how to tell a sprain from a more serious injury such as a fracture. If the following happen, you should contact your doctor: Your pain is severe or uncontrolled, in spite of over-the-counter medications, elevation, and ice. You cannot walk or cannot walk without severe pain. Your ankle fails to improve within 5-7 days. The pain need not be gone, but it should be improving. A follow-up visit 1-2 weeks after the injury is advisable to help with flexibility and strengthening exercises. The indications to go to a hospital's emergency department are similar to those for which to call the doctor. The following conditions suggest you might have a fracture, or you may need a splint for pain control. Severe or uncontrolled pain Foot or ankle is misshapen or extremely swollen Cannot walk without pain Severe pain when pressing over the medial or lateral malleolus, the bony bumps on each side of the ankle The doctor will check to see if a fracture or other serious injury has happened to require immediate care. The examination should make sure that you haven't injured the nerves or arteries to the foot. The doctor will handle and move the foot and ankle to determine what bony areas are involved. The doctor will also check the Achilles tendon for signs of rupture. X-rays are often, but not always, needed to make sure that a fracture is not present. Care at home is directed toward lessening the pain and helping healing. Because most of the pain is caused by inflammation, you should try to reduce inflammation and keep it from happening. Remember R. I. C. E.: Rest prevents further injury and avoids stress on already inflamed tissue. Put the ankle joint at rest by wearing a brace or splint. Ice is probably the best treatment. Ice will counteract the increased blood flow to the injured area. It will reduce the swelling, redness, and warmth. Applied soon after the injury, ice will prevent much of the inflammation from happening. Compression can help keep down swelling. Compression wraps, such as Ace bandages, do not provide much support to prevent movement of the ankle, and you should not apply them tightly. Specialized braces, such as for the ankle, can work better than an elastic bandage for removing the swelling. Elevation (keeping the injured area up as high as possible) will help the body absorb fluid that has leaked into the tissue. Ideally, prop the ankle up so that it is above the level of your heart. You can do this in a reclining chair. Anti-inflammatory pain medications will reduce the pain and combat the swelling. Several are available over-the-counter, such as ibuprofen ( Motrin, Advil) and naproxen ( Aleve). But check with your doctor first if you have any medical problems or take any other medicines. Treatment by a doctor will be very similar to that described for home care, especially using ice to lessen the inflammation. The doctor may elect to apply a brace or cast to reduce motion of the ankle. Crutches are frequently provided so you do not have to bear weight on the injured ankle. The most common medications used for ankle sprains are anti-inflammatory pain medications that both reduce pain and help control inflammation. If you cannot tolerate these drugs, acetaminophen ( Tylenol) is a common alternative for pain relief. Follow-up for ankle sprains is needed only if the ankle is not healing well. This could indicate there is a previously undetected fracture or torn ligaments. Go to a doctor for follow-up care if either of the following is true. Your ankle continues to hurt after 2 weeks Any swelling persists or worsens Ankle sprain prevention can be as simple as wearing the right shoes or as complicated as balance training for athletes. Keep your ankles strong and flexible. Check with your doctor or physical therapist for strengthening exercises. Wear the proper shoes for the activity. You should always wear stable shoes that give your ankle the proper support. High-top basketball shoes are a good choice. ( High heels or platform shoes are not the best choice if you're trying to prevent an ankle sprain.) If you are participating in a sport, you might want to consider having a weak ankle taped to offer extra support. If you have repeated sprains, wearing an ankle brace while playing may help as well. Make sure that the playing field is clear of any holes or obstacles. Remove any obstacles or trip hazards from your home or yard. Most ankle sprains heal without complications or difficulty. Surgery is seldom needed for mild or moderate sprains. It is sometimes considered when a person with a severe sprain is a professional athlete or someone else who will likely put a lot of stress on the joint in the future. Exercises to maintain flexibility and strength can often be started once the swelling has resolved and you can walk without pain. Check with your doctor first. Media file 1: Ankle sprain. Medial and lateral malleoli, the "bumps" on either side of the ankle. The medial malleolus is formed by the tibia, while the fibula forms the lateral malleolus. Media file 2: Ankle sprain. Inversion injury of ankle. Note it is turned inward. ankle sprain, twisted ankle, turned ankle, rolled ankle, tibia, medial malleolus, fibula, talus, anterior talofibular ligament