If you’ve rolled your ankle joint before, you have a higher chance of getting it injured again. So, to prevent this from happening, let’s talk about what ankle sprain is most common and why it matters.
Some ankle sprains happen more often than others. This is due to differences in ankle motion and structure. And for these same reasons, a lateral ankle sprain is more common than its other counterparts.
So what are other types of ankle ligament injuries? And why does one happen more frequently than other ankle injuries?
What is the most common type of ankle sprain?
Lateral ankle sprains are the undisputed, most common type of sprained ankle. Also known as an inversion ankle sprain, it accounts for about 85% of total cases of these injuries. (1)
With a lateral ankle sprain, there’s a chance you have a torn ligament on your outer ankle. These ligaments include:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
Among the three, the ATFL is the most commonly affected.
Learn more: Our complete guide on ankle sprains
What makes inversion sprains the most common ankle sprain?
To better understand this, first, you need a basic understanding of how your ankle works. Your ankle joint allows movement in four directions:
- Plantar flexion (Foot pointing down)
- Dorsiflexion (Foot pointing up)
- Inversion (Toes pointing to the inside)
- Eversion (Toes pointing to the outside)
We use all four whenever we walk or climb the stairs. But of all those four, plantarflexion and inversion have the most range of motion.
If both these motions combine in an uncontrolled manner, much like twisting your ankle joint, it will put too much tension on your lateral ligaments, resulting in a lateral ankle sprain.
Other types of ankle sprain
Medial ankle sprain
A medial ankle sprain is an injury that happens to the ligament of your inner ankle (deltoid ligament). They rarely happen because of the strength of your deltoid ligament.
But, when they do happen, it’s because you suddenly twisted your foot outwards. If the force is too much for your deltoid ligament, it can tear off its bony attachment, often leading to an avulsion fracture.
So, while medial ankle sprains rarely happen, they’re also a far worse injury. Recovery can take anywhere from 3 weeks to 3 months.
Learn more: Full guide on medial (eversion) sprains.
High ankle sprain
High ankle sprains affect athletes involved in sports with cutting and running. It is an injury to the syndesmosis between your shin and calf bone.
A syndesmosis is a type of ligament that connects two long bones. In our legs, it helps absorb impact and provide stability.
That’s why there’s a high chance for chronic ankle instability when a high ankle sprain is neglected.
Recovering from a high ankle sprain can take 2 weeks to 4 months.
3 Grades of ankle sprains
About 51% of those presenting for acute care are ankle injuries. (2) And, generally, those involved in sports and the military tend to suffer worse ankle sprains.
Having said that, these injuries are graded based on how much damage your ankle ligaments sustained (3).
Grade 1 (Minor Sprain)
Your ankle ligaments are stretched to their limits. Microscopic tears may also be present along ligament fibers.
Even with an injury, your ankle still feels stable, with only minimal pain with walking. There may also be some swelling along the outer part of your ankle, which will subside after a few days.
Recovery may take 3 days to 14 days.
Grade 2 (Moderate Sprain)
A slight tear on your lateral ligaments in which both the ATFL and CFL are involved.
There is a noticeable “giving away” feeling whenever you walk on your injured ankle. Also, swelling can happen almost immediately after the injury, with moderate pain and bruising along your outer foot.
It can take you 4 weeks to 6 weeks before your ankle fully recover.
Grade 3 (Severe Sprain)
Full, complete tear of your lateral ligaments with involvement of your joint capsule.
You may hear an audible “snap” during your injury. It can be difficult to stand, much more to walk, due to the severe pain. There is also possible hemorrhage within the joint capsule.
Severe sprains take 2 months to 4 months of rehab to heal. Some may even need ankle surgery due to their occupation, such as athletes and those in the military.
Further reading: The 3 grades of ankle sprains + treatments for each.
Risk factors for an ankle sprain
Previous ankle injury
You have a 47% increased chance of suffering another sprain if you already had one before. (4) This may be due to nonoptimal body position sense (proprioception) and poor healing.
Participating in high-energy sports
16-40% of all sports-related injuries are ankle sprains. Athletes who play basketball, American football, and soccer are more prone to this injury. This is due to the quick cutting and change of direction of their sport. (5)
Active-duty military personnel
About 103 sprains per 1000 soldiers happen per year. (6) This is from the variable terrains they have to navigate. Also, another factor is combat boots. They aren’t exactly the most comfortable to use for long periods.
Women have a 25% increased chance of having a mild ankle sprain than men. (7)
It may be because of the following (8):
- Hormone differences, such as higher estrogen levels, may affect ligament laxity
- Greater muscle and ligament flexibility but with less powerful muscles to counteract
- Wider pelvis which alters ankle alignment
High Body Mass Index
The higher the BMI, the more joint torque your ligaments need to resist. (9)
High intensity/ long-duration activities.
Either of these two can induce muscular fatigue. This can decrease reaction time and ankle proprioception, which are vital for preventing ankle sprains. (10)
Should I be concerned if I sprained my ankle many times?
Yes! Poorly managed ankle sprains can mess up your body’s position sense – aka proprioception. This can lead to recurrent ankle sprains that can cause other complications. (11)
Can I play with an ankle sprain?
I don’t recommend playing sports while you are still recovering. This may lead to a longer healing period and even more complications. (12)
Conclusion: What is the most common ankle sprain
So to summarize:
- A lateral ankle sprain is the most common type of ankle injury
- Recovery will vary depending on its severity and your previous level of activity
- Conservative treatment, such as RICE therapy, work well with ankle sprains
- Chronic ankle instability may need ankle surgery
- 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
- Tran, Khai, and Suzanne McCormack. Exercise for the Treatment of Ankle Sprain: A Review of Clinical Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health, 3 April 2020. https://pubmed.ncbi.nlm.nih.gov/33074633/
- 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
- 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
- Halabchi, Farzin, and Mohammad Hassabi. “Acute ankle sprain in athletes: Clinical aspects and algorithmic approach.” World journal of orthopedics vol. 11,12 534-558. 18 Dec. 2020, DOI: 10.5312/wjo.v11.i12.534
- Bulathsinhala, Lakmini et al. “Epidemiology of Ankle Sprains and the Risk of Separation From Service in U.S. Army Soldiers.” The Journal of orthopaedic and sports physical therapy vol. 45,6 (2015): 477-84. DOI: 10.2519/jospt.2015.5733
- Hosea, T M et al. “The gender issue: epidemiology of ankle injuries in athletes who participate in basketball.” Clinical orthopaedics and related research ,372 (2000): 45-9. DOI: 10.1097/00003086-200003000-00006
- Shmerling, Robert. “The gender gap in sports injuries”. Harvard Health Blog. Harvard Health Publishing. 22 June 2020. https://www.health.harvard.edu/blog/the-gender-gap-in-sports-injuries-201512038708#:~:text=For%20example%2C%20the%20typical%20female,of%20the%20knee%20and%20ankle
- Tyler, Timothy F et al. “Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index.” The American journal of sports medicine vol. 34,3 (2006): 471-5. DOI: 10.1177/0363546505280429
- Webster, Courtney A, and Maury A Nussbaum. “Localized Ankle Fatigue Development and Fatigue Perception in Adults With or Without Chronic Ankle Instability.” Journal of athletic training vol. 51,6 (2016): 491-7. doi: 10.4085/1062-6050-51.9.02
- Sarcon, Aida K., et al. “Lateral Ankle Sprain and Chronic Ankle Instability.” Foot & Ankle Orthopaedics, Apr. 2019, doi:10.1177/2473011419846938.
- Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
- Dizon, Janine Margarita R, and Josephine Joy B Reyes. “A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players.” Journal of science and medicine in sport vol. 13,3 (2010): 309-17. DOI: 10.1016/j.jsams.2009.05.002