Twisted Your Ankle at Footy? Steps to Take Immediately

Around 275 Australians turn up to an emergency department with an ankle sprain every single day – and up to three‑quarters of people who roll an ankle will do it again, with almost half reporting ongoing problems years later.

If you’ve just twisted your ankle at footy, netball or a social kick of soccer, that’s probably not the stat you wanted to hear.

You might be sitting on the sideline right now, boot off, ankle ballooning, wondering:

• Is this “just a sprain” or something broken?
• Do I really need an X‑ray?
• Can I manage this at home with the RICE method, or do I need a sports injury referral?
• Is it worth seeing a physio, or will it settle if I rest?
• Can I get an x‑ray referral online or a medical certificate without dragging myself to a clinic?

This guide is for you.

We’re an Australian telehealth service, and we speak to people every week who’ve rolled an ankle at weekend sport and are stuck deciding between “walk it off” and “go to ED”. In this article, we’ll walk you through:

• The exact steps to take in the first minutes and hours after a twisted ankle
• How to use the RICE method properly (and what to avoid in those early days)
• Sprained ankle treatment after the initial shock – including when movement is actually good for healing
• How doctors decide if you need X‑ray, ultrasound or MRI, and when an x‑ray referral online is appropriate
• When a physiotherapy referral or sports injury referral to a specialist is worth it
• Where telehealth fits safely (and where it absolutely doesn’t) in ankle injuries in Australia

By the end, you’ll know exactly what to do tonight, what to watch for over the next 72 hours, and how to get the right help – without unnecessary scans or weeks of preventable hobbling.

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Why ankle sprains are such a big deal in Australia

Sport is almost a national religion here. In 2023–24, about 85% of Australians aged 15+ did some sport or physical activity, and around 19% of participants were injured in that year. More than 62,000 sports injuries were serious enough to require a hospital stay.

Ankles cop a lot of that impact:

• Ankle sprains are one of the most common injuries in sport worldwide, especially in court and field sports like netball, basketball, rugby and soccer.
• One Australian estimate suggests around 230,000 GP visits for ankle sprains or strains each year, and that ankle sprains make up about 15% of all sports injuries in some codes.
• A physio‑led Australian review found about 74% of people who sprain an ankle will re‑sprain it, and almost 50% still have pain or instability years later if it’s not managed well.

So while “rolled ankle at footy” sounds minor, the consequences don’t have to be. The good news: early, evidence‑based sprained ankle treatment – including proper use of the RICE method and timely rehab – can dramatically reduce your risk of long‑term issues.

What actually happens when you “roll” your ankle?

Most footy and netball ankle injuries are lateral ankle sprains – you land with your foot pointing down and twisting inward, overstretching or tearing the ligaments on the outside of the ankle.

Those ligaments are like tough straps of fibre that stabilise the joint. When they’re forced beyond their limit, they can:

• Stretch slightly (microscopic tears)
• Partially tear
• Completely rupture

Healthdirect and NPS MedicineWise both describe three general grades of ankle sprain:

• Grade I (mild)
  • A few ligament fibres torn
  • Mild pain and swelling, usually able to walk (maybe with a limp)
• Grade II (moderate)
  • Larger proportion of fibres torn
  • More swelling and bruising
  • Painful to walk, might struggle with stairs or uneven surfaces
• Grade III (severe)
  • Complete tear of a ligament
  • Significant swelling, bruising and instability
  • Often unable to weight‑bear; sometimes associated with fractures or other structural injury

The tricky bit: you can’t reliably tell the grade yourself on the sideline, and even experienced clinicians base their assessment on a combination of:

• How the injury happened
• Where the pain and tenderness are
• How much you can move and weight‑bear
• Whether any bones might be involved

So instead of trying to guess “what grade” you’ve got right now, focus on what to do next.

Step 1: Right there on the field – stop and protect

As soon as you feel that sharp twist and pain:

1. Stop playing immediately

“Running it out” is a great way to turn a simple sprain into a much bigger problem. Continuing to play on a damaged ligament increases bleeding and swelling and can worsen the tear.

1. Check for emergency red flags

Call 000 or go straight to the nearest emergency department or urgent care clinic if:

• The ankle, foot or lower leg looks clearly deformed (foot at a strange angle, obvious dislocation)
• There’s a bone visible or a deep wound over the joint
• You cannot put any weight at all on the leg, even to shuffle a few steps
• The area is becoming numb, pale, cold or you can’t move your toes
• Pain is severe and rapidly worsening, especially after a big tackle or fall from height
• You have other concerning symptoms (head injury, chest pain, shortness of breath, feeling very unwell)

These can signal fractures, dislocations, vascular injury or other serious trauma that must be assessed in person, not via telehealth.

1. Get off the field safely

If there are no obvious red flags, have teammates help you off the ground. Don’t hop long distances on the sore leg – that can aggravate things.

1. Remove your boot or shoe early

Once swelling sets in, removing a tight boot can become extremely painful (or impossible). As soon as you’re safely off the field and seated, gently remove the shoe and sock, supporting the ankle as you go.

1. Support the ankle

If you have a compression bandage or sports tape in the kit, loosely support the joint (we’ll talk more about compression shortly). If not, just keep the leg elevated and still until you can get home or to a clinic.

Step 2: The first 48–72 hours – RICE method done properly

For many mild to moderate sprains without red flags, early first aid at home makes a big difference. Australian resources like Healthdirect and NPS MedicineWise recommend the RICE method (often expanded to RICER) in this acute phase.

RICE method for ankle sprain

R – Rest

• In the first 24–48 hours, avoid putting full weight through the injured ankle.
• Use crutches if you have them and it’s too painful to walk normally.
• Think “relative rest” – you’re protecting the ankle from further damage, not immobilising your whole body.

I – Ice

• Apply a cold pack or bag of frozen peas wrapped in a thin cloth to the ankle.
• Aim for 15–20 minutes every 2–3 hours while awake in the first couple of days.
• Never put ice directly on skin (risk of ice burn), and don’t leave it on for long stretches.

Ice helps reduce pain and moderates excessive swelling. Some newer opinions question heavy, prolonged icing, but short, intermittent cooling in the first hours is still widely used and considered reasonable for pain relief.

C – Compression

• Wrap the ankle with an elastic compression bandage from just above the toes to well above the ankle bone.
• It should feel firm but not painful – if your toes become numb, blue, cold or tingly, loosen it immediately.
• Take the bandage off at night to avoid it becoming too tight while you sleep.

Compression can help limit excessive swelling and give a sense of support.

E – Elevation

• Whenever you’re sitting or lying down, prop your leg up, ideally so the ankle is above the level of your heart.
• Use pillows on the couch or at the end of the bed.
• This uses gravity to help fluid drain away, reducing throbbing and swelling.

NO HARM: what to avoid early on

Australian guidelines also emphasise NO HARM for the first 48–72 hours:

• No Heat – hot baths, saunas and heat packs increase blood flow and swelling.
• No Alcohol – can worsen swelling and dull your sense of pain, so you may overuse the joint.
• No Running – or vigorous activity on the injured ankle.
• No Massage – deep massage over the injured area too early can aggravate bleeding.

Pain relief – helpful, but check what’s safe for you

Over‑the‑counter pain relief (for example, paracetamol or, for many people, an anti‑inflammatory like ibuprofen) can make it easier to rest and start gentle exercises. But:

• Not everyone can safely take anti‑inflammatories (e.g. certain kidney, heart, stomach conditions or pregnancy).
• Always read the packet, stick to recommended doses, and ask your pharmacist or doctor if you’re unsure.

Pain control isn’t about “masking it and going flat‑out” – it’s about staying comfortable enough to move within sensible limits.

Step 3: Sprain vs fracture – do you need an X‑ray?

When your ankle is swollen and painful, it feels like something must be broken. But the research tells a more reassuring story:

• Only about 15% of acute ankle injuries turn out to be fractures in hospital settings – most are soft‑tissue sprains.
• X‑rays are excellent at spotting broken bones, but they can’t show ligament tears directly.

Because unnecessary imaging costs time, money and radiation exposure, Australian bodies like NPS MedicineWise and Choosing Wisely recommend using the Ottawa Ankle Rules to decide who actually needs a scan.

In plain English: when doctors worry about fractures

Your GP, ED doctor or urgent care clinician will consider an ankle or foot X‑ray if you’ve had a twisting injury and:

• There is tenderness over the bony bumps on either side of the ankle (medial or lateral malleolus)
• There is tenderness over the base of the 5th metatarsal (outer side of mid‑foot) or the navicular (inner mid‑foot)
• You cannot take four steps on the injured leg, both at the time of injury and when examined

These are the key parts of the Ottawa Ankle Rules, which have been shown to be highly sensitive for picking up significant fractures and are recommended across Australia.

When you should seek urgent in‑person assessment

Get a same‑day review at an ED, urgent care clinic or GP if:

• You cannot bear any weight at all on the ankle after the first few hours
• The ankle looks crooked, unstable or badly swollen compared to the other side
• Pain is severe and not easing with rest and basic pain relief
• You have bone‑point tenderness directly over the ankle bones or mid‑foot
• There was a high‑energy mechanism (e.g. big tackle, fall from a height, car accident)
• You’re older or have osteoporosis and the ankle gave way from a seemingly minor twist

In those situations, getting an X‑ray the same day is usually the safest move.

How an x‑ray referral online fits in

Often, once a doctor has taken a good history and (where possible) examined you, it’s clear whether an X‑ray is needed.

• In non‑emergency cases, a GP – including a telehealth GP – can issue an imaging request form electronically for you to take to a local radiology clinic.
• At NextClinic, our telehealth doctors can usually make this call after a detailed phone consultation, asking about your ability to walk, where it hurts, and how the injury happened. If an X‑ray is appropriate, we can provide an x‑ray referral online that any Australian imaging provider can use, just like one from a face‑to‑face GP.

Just as importantly, if we think you need hands‑on assessment or emergency care instead, we’ll tell you that clearly and point you in the right direction.

Step 4: Do you need ultrasound or MRI?

People often jump straight to “Do I need a scan?” when they sprain an ankle.

Australian consumer guidance from NPS MedicineWise is very clear: for most simple sprains, a careful history and physical exam are just as accurate – or more accurate – than an ultrasound, and MRI is usually reserved for more complex or persistent cases.

Broadly:

• Ultrasound
  • May be used if there’s uncertainty about which structures are damaged (for example, peroneal tendon tears).
  • Should generally be ordered only if the result will actually change your treatment.
• MRI
  • Occasionally used when pain and instability persist for months despite good rehab.
  • Helpful for suspected cartilage injuries, subtle fractures, or complex ligament damage before considering surgery.

Most Australians with ankle sprains never need MRI, and many don’t need ultrasound either. If your symptoms aren’t following the usual healing pattern, your GP might first refer you to a sports physician, orthopaedic surgeon or specialist foot/ankle clinic – that’s where a sports injury referral comes in.

At NextClinic, our doctors can:

• Review your story and any existing imaging
• Decide whether another scan is likely to change management
• Provide a specialist referral if a sports physician, orthopaedic surgeon or other specialist input is appropriate

Step 5: After the first few days – movement, strength and balance

Here’s where many Aussies go wrong: the ankle swells, they rest on the couch for two weeks, then try to jump straight back into footy. That “all‑or‑nothing” approach is a big reason re‑sprains are so common.

Once:

• The worst of the pain has settled, and
• Swelling is no longer rapidly increasing

…it’s time to gradually reintroduce movement.

Why movement matters

Healthdirect and NPS both emphasise that, after the acute phase, gentle exercises and then strengthening are crucial for good recovery:

• Movement maintains joint flexibility and prevents stiffness.
• Strength work helps the muscles around the ankle support the joint.
• Balance (proprioception) exercises retrain your brain to know where your foot is in space, drastically reducing re‑injury risk.

Simple early exercises (within your pain limits)

After a clinician has confirmed there’s no fracture and you’re safe to start rehab, common starting points (which a physio can tailor) include:

• Range‑of‑motion exercises
  • Gently drawing circles in the air with your toes
  • Slowly pulling your foot up and pointing it down while seated
• Isometric strength
  • Pushing your foot lightly against a fixed object (like your hand or a towel) in different directions without moving the ankle much
• Early balance work
  • Standing on both feet, then gradually shifting more weight onto the injured side as tolerated
  • Progressing to brief periods of standing on the injured leg only, near a wall or bench for support

Pain should be mild and manageable – a bit of discomfort is expected, sharp or worsening pain is a sign to back off and seek advice.

When a physiotherapy referral is worth its weight in gold

Given how common re‑sprains and chronic ankle instability are, there’s a strong case for getting a physiotherapist involved for anything beyond the most minor tweak. Large reviews estimate that up to 40% of people develop ongoing ankle instability after a sprain – often related to inadequate rehab.

You should seriously consider seeing a physio – or asking your GP or telehealth doctor for a physiotherapy referral – if:

• You’re still limping after 3–5 days
• You can’t walk normally on flat ground within 1–2 weeks
• The ankle feels like it “gives way”, especially on uneven surfaces
• This is not your first sprain on the same side
• You play in a competitive league where cutting/landing mechanics matter (AFL, NRL, touch, netball, basketball, soccer, etc.)

In Australia:

• You can book a private physio directly (no referral required), but
• A formal physiotherapy referral from a GP or telehealth doctor can be useful for:
  • Communication between your doctor and physio
  • Certain funding arrangements (like chronic disease management plans)
  • Insurance, workplace or sports admin that require documentation

At NextClinic, our doctors regularly issue physio referrals for sports injuries, including ankle sprains, as well as sports injury referrals to sports physicians or orthopaedic surgeons when needed.

If you’d like a deep dive into how referrals work for sports injuries more broadly (including cricket, knees and shoulders), we unpack that in our Backyard Cricket Injuries: When You Need a Specialist guide on our blog.

Step 6: Specialist referrals, X‑rays and MRIs – who does what?

It can be confusing to know which health professional to see when your ankle isn’t improving.

GP or telehealth GP

Best for:

• Initial assessment of most non‑emergency ankle sprains
• Deciding whether you need imaging (X‑ray, ultrasound, MRI) based on the Ottawa Ankle Rules and exam
• Prescribing appropriate pain relief (if safe for you)
• Issuing sports injury referrals to:
  • Physiotherapists
  • Sports physicians
  • Orthopaedic surgeons
  • Podiatrists or other allied health

In Australia, GP‑issued specialist referrals are how you access Medicare rebates for most specialists.

Our own telehealth consultations at NextClinic are designed exactly for this kind of scenario – you complete a brief online questionnaire, then an Australian‑registered doctor calls you (usually within an hour) to assess the injury and arrange any necessary scripts or referrals.

Physiotherapist

Ideal for:

• Guiding rehab and return‑to‑sport after ankle sprains
• Designing a strength and balance program tailored to your sport (e.g. landing drills for netball, cutting for AFL)
• Identifying patients who may need a specialist referral because progress isn’t following the usual pattern

Our doctors can write a physiotherapy referral that outlines the suspected diagnosis and any imaging results, so your physio starts with the full picture.

Sports physician or orthopaedic surgeon

You usually reach this level via a specialist referral from a GP when:

• You’ve had 3+ months of good physio and still have significant pain, instability or locking
• Imaging shows fractures, cartilage damage or complete ligament ruptures
• You’re an athlete with ongoing performance‑limiting symptoms despite conservative care

At that point, the specialist might:

• Order more advanced imaging (e.g. MRI)
• Offer injections or other non‑surgical options
• Discuss surgical stabilisation or repair in selected cases

Our blog post on How to Fast‑Track Your Specialist Referral breaks down how referrals work, how long they last, and how online referrals can help you get onto waitlists sooner.

Step 7: Where telehealth helps – and where it doesn’t

Telehealth has become a standard part of care in Australia, with many people preferring a quick phone consult over a long wait at the GP.

For a twisted ankle from footy, telehealth works well when:

• You’re not in immediate danger, but you’re unsure how serious the injury is
• You want to know if you can safely manage with RICE at home or should head for in‑person care
• You need a medical certificate for sick leave because you can’t perform your usual job (e.g. standing all day, driving, manual handling)
• You’re seeking a physiotherapy referral or sports injury referral (e.g. sports physician, orthopaedic surgeon)
• You already have X‑ray or ultrasound results and want help understanding what they mean and what to do next

Our doctors at NextClinic can, after a phone consult:

• Talk you through appropriate sprained ankle treatment at home
• Provide an x‑ray referral online if imaging is warranted
• Issue a physiotherapy referral or specialist referral letter
• Arrange an online medical certificate if you’re unfit for work or study due to the injury

If you’re curious about the legality and acceptance of online medical certificates in Australia, we cover that in depth in our blogs Online Medical Certificate and Are Online Medical Certificates Valid in Australia?

*Telehealth is not appropriate* if:

• You have any of the emergency red flags mentioned earlier (severe deformity, bone visible, inability to bear any weight with extreme pain, major head injury signs, heavy bleeding, feeling very unwell)
• There’s a possibility you need urgent procedures, casting or on‑the‑spot imaging
• You’re a child with a serious‑looking injury (paediatric ankle rules differ slightly and often warrant a lower threshold for in‑person review)

In those situations, no responsible telehealth provider – including us – should try to manage your ankle online. We’ll direct you to call 000 or present to an emergency department or urgent care centre instead.

Quick recap checklist: twisted ankle at footy

When you twist your ankle on the field, think of this as your step‑by‑step playbook:

1. Stop immediately. Don’t try to “run it off”.
2. Scan for red flags. If there’s deformity, exposed bone, total inability to weight‑bear, severe pain, numb toes or you’re otherwise very unwell, call 000 or go straight to ED.
3. Initial first aid (if non‑emergency):
   • Rest (avoid full weight‑bearing)
   • Ice (15–20 minutes every 2–3 hours, wrapped)
   • Compression bandage (firm but not tight)
   • Elevation (ankle above heart level)
   • NO HARM (no heat, alcohol, running or massage) for 48–72 hours
4. See a doctor promptly if:
   • You can’t take four steps on the injured leg
   • There’s bone tenderness over the ankle or mid‑foot
   • Swelling and pain are severe or rapidly worsening
5. Ask about X‑rays and scans wisely. Most sprains don’t need ultrasound or MRI, and X‑rays are guided by the Ottawa Ankle Rules, not just pain level.
6. Start movement and rehab as soon as it’s safe, focusing on range of motion, strength and especially balance.
7. Get a physiotherapy referral or book a physio directly if:
   • You’re still limping after a few days
   • You can’t get back to normal walking or sport over the next few weeks
   • Your ankle feels unstable or this is a repeat injury
8. Use telehealth smartly. For non‑emergency cases, a telehealth GP (including our doctors at NextClinic) can:
   • Triage severity
   • Provide sprained ankle treatment advice
   • Issue x‑ray referrals online
   • Arrange physiotherapy referrals, sports injury referrals and online medical certificates where appropriate

A quick but important disclaimer

This article is general information for adults in Australia. It can’t replace personalised medical advice from your own doctor or physio. If you’re unsure how serious your injury is – or your gut says, “This feels wrong” – err on the side of getting in‑person care.

Your next step (literally): what to do this week

Let’s bring it back to you and your ankle.

If you’ve recently twisted your ankle at footy, netball or any weekend sport, choose one practical step from this list to put into action this week:

• Book an appointment (in‑person or telehealth) to check whether you need an x‑ray referral or physio.
• If you’ve already seen a doctor, organise a physiotherapy referral or make that first physio booking you’ve been putting off.
• Start a simple daily balance routine (for example, standing on one leg while brushing your teeth) once it’s safe – and stick with it.
• If you’re off work because of your ankle and struggling to get to a clinic, arrange an online medical certificate and telehealth check‑in so you’re covered while you recover.
• Re‑check your return‑to‑play plan: are you pain‑free, walking normally, and able to hop or change direction comfortably before you head back into full training?

Then, we’d love to hear from you:

Which strategy are you going to try this week – and what difference does it make? Share your plan or your results in the comments. Your experience might be exactly what another weekend warrior needs to read before they decide whether to “walk it off” or finally give that ankle the care it deserves.

References

• Lifecare
• Sports injury in Australia, Introduction - Australian Institute of Health and Welfare
• Sports injury in Australia, About - Australian Institute of Health and Welfare
• Ankle sprains: 10 things you should know
• Sprains and strains | healthdirect
• RICE Method: Rest, Ice, Compression, & Elevation
• Acute ankle and knee injuries: Limited role for imaging
• Acute ankle and knee injuries
• Ottawa ankle rules (adult) | Appendix | Emergency care assessment and treatment
• Online Doctors: Telehealth Consultations at NextClinic
• How to Fast-Track Your Specialist Referral | NextClinic
• Ankle sprains | Health & High Performance | Australia
• Backyard Cricket Injuries: When You Need a Specialist | NextClinic
• Telehealth and Rural Australia: Closing the Gap | NextClinic
• Online Medical Certificate | NextClinic
• Ottawa ankle rules (paediatric) | Appendix | Emergency care assessment and treatment

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