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  • Writer's pictureUltra Sports

How to manage a rolled ankle

Updated: Feb 10, 2019

June is an exciting time for fans of British Horse Racing. We have the Investec Derby Festival at the beginning of the month and Royal Ascot later in the month of June.

Pundits flock from all over the UK and Europe to be a part of the festivities. The stakes are high and the heels are higher. As stylish as Jimmy Choo and Christian Louboutin heels are, they are not designed for the undulating terrain of Epsom Downs Racecourse. Because of this, dozens of race goers every year end up at the first-aid tent seeking treatment for rolled ankles.

We hope that our Ultra Sports Clinic patients survive race day unharmed. But in case an ankle sprain does happen, this article is here to help.


Interesting Fact: Ankle Sprains make up 300,000 visits annually to UK A&E departments


How to manage a rolled ankle?

Step 1: Evaluation Some rolled ankles can result in fractures, in which case a visit to A&E might be needed. As health practitioners, we use the Ottawa Ankle Rules to decide whether X-Ray or other imaging is indicated. If you refer to figure 1, you’ll see the Ottawa Ankle Rules. If your ankle meets this criteria, head to A&E or your GP for further examination by a health professional.

Figure 1:

Ottawa Ankle Rules – X-Ray is indicated if there is: - Bone tenderness at zones A), B), C) or D) - Inability to weight bear both immediately and in A&E

Step 2: Initial Management

After evaluating your ankle using the above method, you can begin managing it using the R.I.C.E principle. The first 24 hours are the most important in the management of any soft tissue injury. When soft tissue is injured, blood vessels are typically damaged too resulting in blood accumulating around adjoining tissues. This can result in secondary hypoxia and further tissue damage. With this in mind, R.I.C.E is an effective way to reduce the bleeding in the injured area.

R – Rest I – Ice C – Compression E – Elevation Rest:

Where possible, you should aim to rest your ankle to prevent further bleeding. Activities such as walking, running and jumping will increase bleeding to the affected area and thus should be avoided. Walking aids such as crutches can be utilized to achieve this goal.


Ice should be used immediately post injury to the affected area to help minimize further tissue damage. Although there is no official frequency for application of ice, many practitioners advise using ice for 10-15 minutes every 1-2 hours for the first 24 hours post injury.


Applying a compression bandage to the affected area will reduce bleeding and thus will minimize swelling. Compression can be used in conjunction with ice application. The bandage should be applied firmly to the affected area to ensure it works effectively. However, the bandage should not be so tight that it causes pain. Applying the bandage is very simple; begin distal (away from centre of the body) and wrap proximally (towards the centre of the body). Each new layer of bandage should be overlapping the previous layer by half.


Elevating your lower limb is another effective way to minimize swelling. Elevation decreases hydrostatic pressure and reduces the accumulation of interstitial fluid. In order for this method to be effective, the ankle should be elevated above the level of the pelvis. This can be done by resting the ankle on another chair while sitting or on pillows while sleeping at night.

What to avoid:

In the first 24 hours, it is also important to avoid H.A.R.M as these factors exacerbate swelling.

H – Heat A – Alcohol R – Running M – Massage

What to do next? Call Ultra Sports Clinic and book an appointment. Our skilled Radiologist can thoroughly assess and diagnose the severity of your ankle injury. Our team of physiotherapists are passionate and experienced in assessing, treating and rehabilitating patients with lower limb injuries. If not managed properly, ankle injuries can become recurrent. This can lead to permanent laxity which may lead to ongoing pain and dysfunction in the future.

So stick to gambling on horses at Epsom Downs, not on your health and well-being. Remember, you have ‘One Body, Make it Count.’



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