There are many bones and ligaments in your foot. A ligament is a strong flexible tissue that holds bones together.

When the foot lands awkwardly, some ligaments can stretch and tear. This is called a sprain.

When the injury occurs to the middle part of the foot, this is called a mid-foot sprain.

Mid-foot sprain

Most foot sprains happen due to sports or activities in which your body twists and pivots but your feet stay in place. Some of these sports include football, snowboarding, and dance.

There are three levels of foot sprains.

• Grade I, minor. You have small tears in the ligaments.
• Grade II, moderate. You have large tears in the ligaments.
• Grade III, severe. The ligaments are completely disrupted or detached from the bone.

Symptoms of a foot sprain include:

• Pain and tenderness near the arch of the foot. This can be felt on the bottom, top, or sides of the foot.
• Bruising and swelling of the foot
• Pain when walking or during activity
• Not being able to put weight on your foot. This most often occurs with more severe injuries.

Your health care provider may take a picture of your foot, called an x-ray, to see how severe the injury is.

If it is painful to put weight on your foot, your provider may give you a splint or crutches to use while your foot heals.

Most minor-to-moderate injuries will heal within 2 to 4 weeks. More severe injuries, such as injuries that need a cast or a boot, will need a longer time to heal, up to 6 to 8 weeks. The most serious injuries will need surgery to reduce the bone and allow the ligaments to heal. The healing process can be 6 to 8 months.

Follow these steps for the first few days or weeks after your injury:

• Rest. Stop any physical activity that causes pain, and keep your foot still when possible.
• Ice your foot for 20 minutes 2 to 3 times a day. Do not apply ice directly to your skin. Always wrap it in a cloth or towel.
• Keep your foot raised to help keep swelling down.
• Take pain medicine if you need it.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your provider.

You can begin light activity once the pain has decreased and the swelling has gone down. Slowly increase the amount of walking or activity each day.

There may be some soreness and stiffness when you walk. This will go away once the muscles and ligaments in your foot begin to stretch and strengthen.

Your provider or physical therapist can give you exercises to help strengthen the muscles and ligaments in your foot. These exercises can also help prevent future injury.

Tips:

• During activity, you should wear a stable and protective shoe. A higher-top shoe can protect your ankle while a stiffer sole shoe can protect your foot. Walking barefoot or in flip flops can make your sprain worse.
• If you feel any sharp pain, stop the activity.
• Ice your foot after activity if you have any discomfort.
• Wear a boot if your provider suggests it. This can protect your foot and allow your ligaments to heal better.
• Talk to your provider before returning to any high impact activity or sport.

You may not need to see your provider again if your injury is healing as expected. You will need additional follow up visits if the injury is severe.

Contact the provider if:

• You have sudden numbness or tingling.
• You have sudden increase in pain or swelling.
• The injury does not seem to be healing as expected.

Rose NGW, Green TJ. Ankle and foot injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 49.

Rothenberg P, Swanto E, Molloy A, Aiyer AA, Kaplan JR. Ligamentous injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee Drez & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 117.