Ankle Sprain | Everything You Need To Know

A bad fall, stepping on someone’s foot, or simply a wrong step. These scenarios may be all too familiar especially if you recently had an ankle sprain.

It happens quite frequently – about one out of 10,000 people suffer an ankle sprain daily in Western countries. (1)

And depending on the damage and mechanism of injury, some sprained ankles can take a few weeks to a year to fully recover. (2)

Now, this article will cover everything you need to know about ankle sprains. Here’s what you’ll learn – tap on any topic to go directly to its answer:

• What is an ankle sprain?
• The 3 types of ankle sprains
• Who’s prone to this injury?
• Symptoms of a sprained ankle
• How to know if the injury is serious?
• How are ankle sprains diagnosed?
• What types of treatments are available?
• Can you fully recover from a sprained ankle?
• FAQs

Or read right ahead to learn more.

What is an ankle sprain?

First of all, a sprain is not the same as an ankle strain. An ankle sprain occurs when you overstretch or tear any of your ankle ligaments, while a strain affects the tendons and muscles.

Ligaments are tough bands of tissue that interconnect your bones and keep them stable with every movement. But certain motions can put them under a lot of tension, causing a sprain.

Rolling your foot or a wrong step on an uneven surface are common movements that often lead to this excessive tension, thus causing a sprained ankle. 

Now, our ankle joint has several ligaments. In particular, these major ligament groups are at a higher risk of getting sprained:

• Lateral ligaments: at the outer part of your ankle.
• Deltoid ligaments: at the inner part of your ankle.
• Inferior tibiofibular ligaments: at the front of your ankle, just below your shin bone.

Further reading: How do you sprain an ankle?

The 3 types of ankle sprains

The classification of an ankle sprain depends on which part of the joint was affected. They are:

Lateral ankle sprain

This is your typical ankle sprain. It happens when your foot rolls excessively downwards and in. It’s also called an “inversion injury.”

Here, the ligaments injured are on the outer side of your ankle. But 70% of the time, this injury only involves the anterior talofibular ligament (ATFL). (3)

Lateral ankle sprains account for 85% of most ankle sprains. (4) This high incidence may be because (5, 6, 7):

• These ligaments work harder than the others to keep your ankle stable while walking
• Among the lateral ligaments, the ATFL is the weakest – explaining why it’s the most affected of them all.

Related: What does an ankle sprain feel like?

Medial ankle sprain

This second type of ankle sprain happens when your foot and ankle roll downwards and out. It’s also known as “eversion injury.”

The tissues affected are the deltoid ligaments, the ones located in your inner foot.

With an eversion injury, your deltoid ligaments may pull on its bony attachment to prevent them from tearing off. That’s why a medial ankle sprain often includes a possibility of bone fracture. (8)

Check this out: All about eversion ankle sprains.

High ankle sprain

This sprain can happen when you twist your lower leg with your toes pointing upward and your heel is in contact with the floor.

The tissues affected are the inferior tibiofibular ligaments, the ones at the front of your ankle joint.

This type of ankle sprain is more common in athletes than in the general population. Collision sports like football and ice hockey can make you susceptible to a high ankle sprain. (9)

Learn more: High ankle sprain symptoms, causes, and treatments.

Risk factors for an ankle sprain

People at risk of an ankle sprain are those with (10):

• Previous leg injuries
• High BMI
• Inadequate footwear for sports
• Weak leg muscles
• Lower body hyperlaxity

What are the symptoms of a sprained ankle?

Aside from what type of ankle sprain you have, your symptoms will depend on the severity of your injury. There are 3 grades of severity (5, 11):

Grade 1: Mild sprain

Here, the ankle ligaments are overstretched. There are microscopic tears. Symptoms include: 

• Minor swelling
• Minimal tenderness around the ankle and foot
• Ability to bear weight with some pain

Grade 2: Moderate sprain

This one involves one or more ligaments that are partially torn. Symptoms include: 

• Moderate pain and swelling around the foot and ankle
• Unsteadiness of ankle joint when putting on some weight
• Noticeable limp when walking
• Some loss on ankle range of motion
• Tenderness on involved structures
• Bruising around the ankle joint

Grade 3: Severe sprain

This is the most severe, where the ligaments are torn completely. The joint capsule may be affected as well. Symptoms include: 

• Severe pain at the moment of injury
• Noticeable swelling and bruising around the foot and ankle
• Inability to bear weight on the involved ankle
• Ankle range of motion is difficult to perform

Further reading: The 3 grades of ankle sprains and their treatments.

How do I know if my ankle sprain is serious?

Most sprained ankles get better without any treatment. But for some, it’s best to consult your doctor just to be sure you’re on the right track.

Seek medical attention if you happen to have a few of these symptoms:

• Can’t bear weight on your affected ankle
• Severe tenderness surrounding your foot and/or ankle
• Ankle pain and swelling that won’t go away
• Unusual ankle deformity
• Bluish discoloration of your foot

This can help: Broken ankle vs sprain – how to tell the difference?

How are sprained ankles diagnosed?

Most doctors do the following to diagnose an ankle sprain:

Review the events that caused the ankle injury

Your doctor will ask you to recall the moment of the injury. Here are some things that may indicate it’s an ankle sprain:

• Hearing any pop/snapping sound at the time of injury
• Automatically grabbing your ankle joint afterward
• Inability to walk properly without a limp

Decreased range of motion, pain, and swelling

This is very common after an ankle sprain.

It’s a protective response from your body to prevent reinjury. This lack of mobility combined with pain and swelling sends a message that the area is vulnerable and must be protected to let it heal properly.

Check your ligaments

Your doctor will do specific physical tests to check the state of your ankle ligaments. They can help determine the type and grade of your ankle sprain as well.

Referral for imaging tests

Some of the most common imaging tests for ankle sprains are:

• X-ray and CT scan: Helps to rule out any broken bone, contusion, and effusion
• MRI and ultrasound: Demonstrates what ligament is affected and if it’s stretched or torn

Treatment for a sprained ankle

After a thorough physical exam, your doctor will suggest which course of treatment is best for your injured ankle. The most common options are:

Home treatment

For most mild sprains, this is enough to relieve pain and swelling. Here are 4 effective things that you can do at home to jump-start your recovery:

Learn more: 7 home remedies for ankle sprains

1) RICE therapy

Arguably the most recommended treatment after any injury, RICE therapy stands for:

• Rest: Take a few days off from any aggravating activities.
• Ice: Apply an ice pack over your ankle for 15-20 minutes.
• Compression: Wrap it over an elastic bandage to hold it in place.
• Elevation: Place your foot above chest level.

This protocol helps deal with ankle pain and reduces swelling, especially 4-5 days after your injury.

This will help: How often should you ice your ankle sprain?

2) Over-the-counter pain medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) work by reducing inflammation levels, thereby decreasing pain and swelling.

There are two forms of NSAIDs – topical and oral. Both have different dosages and possible side effects. See your doctor first and check which type of medication will work best for you.

3) Wear an ankle brace

Wearing an ankle brace can protect your ankles from further injury. Some are ideal to help you sleep during the first days of recovery, while others can prevent further injury in your daily life.

There’s a wide variety of ankle braces, with different styles and functions suited for any point of your recovery.

Further reading: Benefits and tips for choosing the best ankle brace

4) Ankle exercises

Resting your ankle can only do so much healing. Adding in ankle exercises that strengthen, stretch, and stabilize your ankle will speed up your recovery and prevent future episodes.

Importantly, ankle exercises can lessen the chance of developing chronic ankle instability (CAI), which occurs in 70% of sprained ankles. (12, 13)

CAI is characterized by (13):

• Perception of “giving way” at your ankles during standing/walking
• Chronic pain over your ankle and foot
• Recurrent sprains
• Ankle weakness and reduced range of motion

Try this: 12 Physio-approved exercises to rehab your sprain at home

Nonsurgical treatment

These treatments can help in any type or grade of ankle sprain:

Physical therapy

A quick recovery from an ankle sprain depends on a proper treatment plan. This is why you should go to physical therapy.

A physical therapist can make a personalized rehabilitation program geared towards your recovery. Your physio will:

• Assess your current condition and previous minor injuries
• Use tools and techniques to decrease ankle pain and swelling
• Give you the right strengthening exercises for your symptoms
• Improve your ankle motion and reduce your risk of future injury

Keep reading: All about physiotherapy for ankle sprains.

Acupuncture

Acupuncture uses fine needles to stimulate acupoints to regulate our flow of energy. For ankle sprains, it’s a cost-effective way to reduce pain and swelling. (14)

Though much has yet to be studied, acupuncture is one of the emerging alternative therapy techniques for a sprained ankle.

Ankle surgery

Different factors can lead people to go for surgery, such as chronic ankle pain, instability, or when non-surgical methods fail.

There are two main surgical procedures for ankle sprain.

The first is ankle arthroscopy. In this procedure, orthopaedic surgeons use a small arthroscopic camera and surgical tools to inspect and repair the ligaments.

The second is lateral ligament reconstruction. It involves making a large incision outside of the ankle. Afterward, your surgeon will tighten your torn ligament by either stitching or anchoring it to your ankle bones.

Regardless of the procedure, your surgeon will refer you to physical therapy to finish your recovery.

Further reading: Treatments for ankle sprains (according to severity)

Can you fully recover from a sprained ankle?

Evidence shows that 80% of patients fully recover from a sprained ankle by nonsurgical means. (5) While others still report symptoms of chronic ankle instability even after a year from their injury. (15)

In terms of the timetable for recovery, it can take from weeks to months. Several factors will influence your healing potential, such as:

• Your age.
• Your previous level of activity.
• The type and severity of ankle sprain.
• How your body responds to treatment.
• How well you adhere to the rehabilitation exercises.

FAQs

Conclusion: What does it mean to sprain your ankle?

Ankle sprain results from twisting or rolling your foot, which damages your ligaments. Each sprain varies, depending on its mechanism of injury, severity, and symptoms.

Most sprains heal on their own in a span of a few weeks. Other times, you may need a medical professional to jumpstart your rehabilitation.

Resources

1. Polzer, Hans et al. “Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm.” Orthopedic reviews vol. 4,1 (2012): e5. DOI: 10.4081/or.2012.e5
2. Hubbard, Tricia J, and Charlie A Hicks-Little. “Ankle ligament healing after an acute ankle sprain: an evidence-based approach.” Journal of athletic training vol. 43,5 (2008): 523-9. DOI: 10.4085/1062-6050-43.5.523
3. Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
4. Ferran, Nicholas Antonio, and Nicola Maffulli. “Epidemiology of sprains of the lateral ankle ligament complex.” Foot and ankle clinics vol. 11,3 (2006): 659-62. DOI: 10.1016/j.fcl.2006.07.002
5. Cavazos GJ Jr., Harkless LB. The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes. J Sports Med Ther. 2021; 6: 008-017. DOI: 10.29328/journal.jsmt.1001052
6. Netto, Cesar D et al. “Foot and Ankle Injuries in Dancers.”Baxter’s the Foot and Ankle in Sport (Third Edition). 2020, Pages 436-453.e1. https://doi.org/10.1016/B978-0-323-54942-4.00024-
7. Myerson, Mark S et al. “Ankle Instability and Impingement Syndromes.” Reconstructive Foot and Ankle Surgery: Management of Complications (Third Edition). 2019, Pages 380-395. https://doi.org/10.1016/B978-0-323-49693-3.00025-1
8. Campagne, Danielle MD. “Ankle Sprains.” MSD Manual. March 2021. https://www.msdmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/ankle-sprains
9. Molinari, A et al. “High ankle sprains (syndesmotic) in athletes: diagnostic challenges and review of the literature.” The Iowa orthopaedic journal vol. 29 (2009): 130-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723709/
10. Beynnon, Bruce D et al. “Predictive Factors for Lateral Ankle Sprains: A Literature Review.” Journal of athletic training vol. 37,4 (2002): 376-380.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/
11. Wolfe, Michael et al. “Management of Ankle Sprains.” Am Fam Physician. 2001 Jan 1;63(1):93-105. https://www.aafp.org/afp/2001/0101/p93.html
12. Doherty, Cailbhe et al. “Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.” British journal of sports medicine vol. 51,2 (2017): 113-125.  DOI: 10.1136/bjsports-2016-096178
13. Herzog, Mackenzie M et al. “Epidemiology of Ankle Sprains and Chronic Ankle Instability.” Journal of athletic training vol. 54,6 (2019): 603-610. DOI: 10.4085/1062-6050-447-17
14. Huang, Fasen et al. “Acupuncture for the treatment of ankle sprain: A protocol for a systematic review and meta-analysis: study protocol.” Medicine vol. 98,46 (2019): e17905. DOI: 10.1097/MD.0000000000017905
15. Hertel, Jay, and Revay O Corbett. “An Updated Model of Chronic Ankle Instability.” Journal of athletic training vol. 54,6 (2019): 572-588. DOI: 10.4085/1062-6050-344-18