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A foot or ankle sprain is a soft tissue injury. Most often, a sprain occurs when an injury pulls, stretches, or tears the ligaments that connect bone to bone.
What is a foot sprain?
A foot sprain is damage to ligaments within the foot. The term "sprain" refers to overstretching or tearing of ligaments — the strong, fibrous bands of tissue that hold the bones together within the joints. Foot sprains are usually sports or dance injuries. Any sort of running movement that involves sudden stops, starts, and twisting can lead to a foot sprain. Suddenly getting the foot caught while walking or running can wrench the ligaments and cause a sprain.
Symptoms include swelling, bruising, and pain in the affected foot, especially with weight-bearing. If symptoms do not resolve quickly or seem to get worse instead of better, a medical provider should be seen to make sure no fracture is involved.
The diagnosis is made through physical examination and imaging such as X-ray, CT scan, ultrasound, or MRI.
Treatment is usually conservative and involves rest to allow healing; nonsteroidal anti-inflammatory drugs (NSAIDs) for pain; elevating the foot to improve circulation; wrapping the foot with an Ace bandage or wearing a special boot for support.
You should go to a retail clinic to have the foot sprain evaluated. Most often, minor sprains can be treated by resting the foot, elevating it while sitting or laying down, and applying an ice pack or heat. Over-the-counter pain medication can help as well.
Symptoms of a foot sprain
Foot sprains are classified into three grades of severity based on associated symptoms. Grade I sprains involve stretching or microscopic tears of the ligaments. Grade II sprains involve more severe stretching or a partial tear of the ligaments. Grade III sprains involve a complete tear of the ligaments.
Most people with foot sprains will experience pain in the foot as well as tenderness when pushing on the foot. The location of the pain and tenderness may vary depending on the specific ligament that is injured. The pain can also be described by the following:
- Pain at the base of the big toe: Forefoot sprains generally cause this type of pain.
- Pain near the arch of the foot: Midfoot sprains generally cause pain in this location.
- Worse with weight-bearing or even unbearable
Some people with foot sprains may develop the following:
- Swelling and/or bruising of the foot: People with forefoot sprains usually develop some degree of swelling or bruising near the base of the big toe. People with isolated midfoot sprains usually develop swelling near the arch of the foot without bruising; however, they may develop bruising in more severe sprains or fractures of the nearby bones.
- Inability to bear weight on the affected foot: In severe foot sprains, the person may be unable to bear weight on the affected foot due to pain. This is more common in Grade II and Grade III foot sprains.
What causes a foot sprain?
The foot can be divided into three regions: the rear foot, the midfoot, and the forefoot. Two common locations for foot sprains to occur are in the midfoot and the forefoot.
In the midfoot, a commonly injured ligament is the Lisfranc ligament, which is a set of three ligaments located in the middle of the foot near the arch. Injury to a foot that is in a stepping position is a common cause of midfoot sprains. Other specifics on risks include:
- Sports: This can happen in sports such as football or soccer when a person steps on another person's foot.
- Dance: This can happen in ballet or other dances if a person loses their balance while pointing their toes.
- Falling or miss-stepping: This can also happen when falling onto the foot after missing a step.
- Car accidents: Less commonly, this can happen during more severe trauma such as a motor vehicle collision.
In forefoot sprains, the ligament in the joint located at the base of the big toe is commonly injured. This type of injury is also known as "turf toe." Hyperextension of the big toe, or bending the big toe backward more than normal, is the most common cause of forefoot sprains. Specific risks include:
- Artificial surfaces: This is commonly seen in sports that involve running on artificial surfaces, such as playing football on artificial turf or practicing ballet.
- Wearing lightweight shoes: The risk is increased when wearing lightweight shoes, which may not provide as much support or protection.
Treatment options and prevention for a foot sprain
Foot sprains are an acute condition but may require weeks or months of treatment to recover function. The treatment required will vary based on the severity (grade) of the injury. Specific treatment options include rest, immobilization, pain medication, and possible surgery.
Rest, ice, elevation and compression (RICE)
Immediately following the injury causing your foot sprain, your physician may recommend various treatments to reduce the swelling and prevent further injury. Your physician may recommend resting the foot for a few weeks for minor/moderate injuries, and up to three to four months for severe injuries. Details include:
- Rest: Rest the foot and prevent it from bearing weight.
- Ice: Apply ice to the area of injury.
- Compression: Place a dressing and wrap on the foot.
- Elevation: Elevate the foot above the level of your heart to reduce swelling.
Following the foot sprain, your physician may also recommend immobilizing the foot in a splint or boot. This protects the foot from further injury, either from movement or from further outside trauma. Your physician may recommend using crutches while the foot is immobilized to prevent weight-bearing.
Your physician may recommend a variety of pain medications to help control the pain. Mild pain can usually be managed with over-the-counter pain medications such as acetaminophen (Tylenol), or NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve). More severe pain may require a course of prescription medications such as tramadol (Ultram).
If your physician says you have a severe foot sprain, he or she may recommend that you have a foot and ankle surgeon evaluate you and determine if you need surgery. Surgical treatment is usually reserved for Grade III sprains, or for any sprains that are associated with fractures of the nearby bones. Surgery may involve positioning the bones back into their proper position, fusing damaged bones together, and/or using plates or screws to hold bones in place. Following surgery, you will need a period of physical therapy and rehabilitation to help in the recovery process.
When to seek further consultation for foot sprain
If you experience any symptoms of a foot sprain, such as foot pain, swelling, bruising, or inability to bear weight, you should see your physician or go to an urgent care center or emergency room. This is especially important if you experienced the type of injury that can commonly cause foot sprains, such as falling onto a foot or hyperextension of the big toe. Your physician can order imaging to determine the extent of the injury and offer the appropriate treatment.
Questions your doctor may ask to determine foot sprain
- Do you have a rash?
- Does your foot hurt very badly when you touch one specific part?
- Is your foot pain constant or come-and-go?
- How long has your foot pain been going on?
- Is your foot pain getting better or worse?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
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- Weatherford BM. Lisfranc (midfoot) injury. American Academy of Orthopaedic Surgeons: OrthoInfo. Published September 2017. OrthoInfo Link
- Ma CB. Foot sprain - aftercare. U.S. National Library of Medicine: MedlinePlus. Published November 27, 2016. MedlinePlus Link