I remember the first time I badly rolled my ankle during a hike — the sharp twinge, the swelling that seemed to appear within minutes, and the uncertainty: what exactly should I do right away to avoid making it worse? Over the years I’ve combined clinical guidance, peer-reviewed recommendations, and practical experience to build a clear, simple plan that I use and recommend for acute foot and ankle sprains. Below is an evidence-based, practical 72-hour approach using cold, compression and elevation (often grouped as the “RICE” or updated “PRICE” principles) to help limit swelling, control pain, and protect tissue while the body starts its repair process.

Why cold, compression and elevation matter in the first 72 hours

Immediately after a sprain, small blood vessels tear, inflammation sets in, and fluid accumulates in the soft tissues. This swelling increases pain and can delay healing by restricting range of motion and increasing tissue stress. The initial 72 hours are important because the inflammatory phase peaks during this time — interventions that safely control swelling and pain can improve comfort and make it easier to progress into gentle movement and rehabilitation.

Cold reduces tissue temperature and nerve conduction speed, which helps with pain and limits blood flow into the injured area. Compression provides an external barrier to fluid build-up. Elevation uses gravity to help drain fluid away from the foot and ankle. Combined, these three are a practical, low-risk way to support early recovery.

Immediate actions (first 0–2 hours)

Right after the injury, my checklist is simple and direct. Quick actions can make a big difference in how much swelling develops.

  • Stop activity and protect the foot — avoid weight-bearing if it’s painful.
  • Assess for serious signs: intense deformity, inability to move toes, major bleeding, or severe pain that feels different from a typical sprain. If any of those are present, seek urgent medical assessment.
  • Begin cold application: use an ice pack, frozen peas, or a gel pack wrapped in a thin towel to prevent skin damage. Apply for 10–15 minutes on, then remove for 10–15 minutes. Repeat while you arrange further care.
  • Start gentle elevation: prop the foot above heart level if possible (for example, lie down with a few pillows under the calf). This immediately helps fluid drainage.
  • Consider a soft compression wrap or ankle brace to provide gentle support — don’t wrap so tightly that circulation is compromised. Check toes for color and warmth.

    • Structured 72-hour plan

    Below I outline a pragmatic schedule you can follow for the first three days. The aim is to control swelling and pain while preventing stiffness and protecting the injured tissues.

    Time frame Goals Actions
    0–24 hours Limit bleeding and swelling, control pain
  • Cold: 10–15 min every 1–2 hours while awake.
  • Compression: Light to moderate compression with an elastic bandage or tubular bandage. Reapply if loose.
  • Elevation: Keep foot elevated above heart level as much as possible.
  • Pain: Use paracetamol or NSAIDs (ibuprofen) if appropriate and not contraindicated; follow dosing guidance.
    		•
    24–48 hours Maintain swelling control, begin gentle movement
  • Cold: Continue 10–20 min sessions 3–4 times daily or as needed for pain.
  • Compression: Continue during daytime, remove for sleep if uncomfortable but keep elevated.
  • Gentle ROM: Start pain-free range-of-motion (ROM) exercises — ankle circles, pointing and flexing toes — several times daily to reduce stiffness.
  • Weight-bearing: Gradually resume partial weight-bearing with protection (crutches or a stiff-soled shoe) as tolerated.
    		•
    48–72 hours Transition toward more active recovery
  • Cold: Use as needed primarily after activity or if swelling increases.
  • Compression: Consider a removable brace for support during activity; supportive footwear for walking.
  • Mobility: Progress ROM and start gentle strengthening (isometric ankle contractions, short calf raises if pain allows).
  • Monitor: If swelling, severe pain, or instability persists, seek further assessment.
    		•

    How to apply cold safely and effectively

    Cold therapy is most effective when used intermittently — continuous icing risks skin and nerve damage. I recommend:

  • Wrap any ice or gel pack in a thin towel.
  • Apply for 10–20 minutes at a time, then remove at least 10–20 minutes.
  • Repeat every 1–2 hours for the first 24 hours, then reduce frequency based on pain and swelling.
  • Avoid direct contact between ice and bare skin, and never sleep with an ice pack in direct contact with the skin.

    • Practical compression tips

    Compression helps limit swelling but must be comfortable and not restrict circulation.

  • Use a graduated elastic compression bandage (e.g., an ACE wrap) or a tubular support.
  • Apply more tension distal-to-proximal (closest to toes to calf) to encourage fluid flow away from the foot.
  • Check toes frequently: if they become pale, cold, numb, or tingly, loosen the wrap immediately.
  • Compression garments from brands like Medi or Bauerfeind provide consistent, easy-to-use support if you prefer not to wrap.

    • Elevation: small adjustments, big impact

    Elevation is simple but underused. When you’re sitting or lying down, aim to keep the foot above the level of the heart. Even small elevations — a pillow under the calf while seated — help. Combine elevation with gentle toe and ankle movements to encourage venous return.

    Pain medication and when to use it

    I recommend paracetamol or an NSAID (ibuprofen or naproxen) for short-term symptom relief if you have no contraindications. Both can help reduce pain and inflammation; NSAIDs have a stronger anti-inflammatory effect. Use the lowest effective dose and follow product guidance. If in doubt, check with a healthcare provider, especially if you have stomach issues, cardiovascular disease, kidney problems, or are taking other medications.

    Red flags and when to see a clinician

    Most mild to moderate sprains improve with the 72-hour PRICE approach and then structured rehab. Please seek urgent medical care if you notice:

  • Severe pain that doesn’t improve with rest, ice and medication.
  • Inability to bear any weight at all.
  • Obvious deformity or an open wound.
  • Numbness, pins-and-needles, or change in skin color and temperature suggesting compromised circulation.
  • Increasing redness, warmth, or streaking — signs of possible infection if there was a break in the skin.

    • What comes after 72 hours

    By 72 hours you should start focusing more on restoring ROM, balance and strength. Gradual loading of the foot and ankle is important; controlled movement encourages healthy tissue remodeling. Depending on severity, a guided rehabilitation program (even a few sessions with a physiotherapist) can speed recovery and reduce re-injury risk. For persistent pain or instability, imaging or specialist review may be necessary.

    If you’d like, I can share simple early rehab exercises you can start after the first 48–72 hours, or a printable checklist to keep near your first-aid kit. Small, consistent steps in the first days after a sprain often determine how quickly and fully you recover — gentle, evidence-based care works.