Ankle Sprain : The Basics You Need To Know !
An ankle sprain is one of the most common sports injuries and can affect athletes, runners, gym-goers and even people during routine daily activities.
It occurs when the ankle suddenly twists, rolls or turns beyond its normal range, causing the supporting ligaments to stretch or tear.
Most ankle sprains are treated without surgery. However, an improperly treated ankle sprain can lead to recurrent ankle sprains, chronic ankle instability, persistent pain and difficulty returning to sports.
Let’s learn some common facts regarding ankle sprains.
What is an ankle sprain?
Ligaments are strong bands of tissue connecting bones to each other. They prevent excessive movement and provide stability to the joint.
An ankle sprain is an injury to one or more ligaments that stabilise the ankle joint.
Most ankle sprains occur when the foot suddenly twists inward, producing an inversion injury.
Ankle sprains are particularly common in sports involving:
Running
Jumping
Sudden changes in direction or pivoting
Landing after a jump
Contact with another player
What causes an ankle sprain?
An ankle sprain can occur during sports or even everyday activities.
Common causes include:
Landing awkwardly after jumping
Sudden change of direction while running
Walking on an uneven surface
Losing balance while walking on footpath or climbing down the stairs
Wearing inappropriate or unstable footwear
Returning to sport before complete recovery from a previous injury
Importantly, a previous ankle sprain significantly increases the risk of sustaining another sprain. That is why proper rehabilitation after the first injury is extremely important.
What are different types of ankle sprains?
Ankle sprains can be classified according to the ligaments involved.
1. Lateral Ankle Sprain
This is the most common type of ankle sprain and affects the outer aspect of ankle.
There are 3 lateral ankle ligaments:
Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Posterior talofibular ligament (PTFL)
It occurs when the ankle twists inwards and injures the ATFL first. More severe injuries may involve the CFL and PTFL.
2. Medial Ankle Sprain
A medial ankle sprain affects the deltoid ligament on the inner side of the ankle.
Deltoid ligament has superficial and deep layers.
These injuries are less common because the medial ligament complex is relatively strong.
A significant medial ankle injury is many times associated with other injuries and hence requires careful assessment.
3. High Ankle Sprain
A high ankle sprain, also called a syndesmotic injury, involves the ligaments connecting the two bones of the leg (tibia and fibula) just above the ankle joint.
High ankle sprains are commonly seen in road traffic accidents, football, basketball, rugby players and other contact-sport athletes
They often take longer to recover than a routine lateral ankle sprain.
What are the grades of ankle sprain?
Ankle sprains are generally classified into three grades:
Grade 1
Ligament fibres are stretched but remain intact.
Mild pain and tenderness.
Minimal swelling.
Walking with a limp is usually possible.
The ankle remains stable.
Grade 2
Partial ligament tear.
More significant pain and swelling.
Bruising can be seen
Walking is quite painful.
Ankle feels unstable on attempt of walking
Grade 3
Complete rupture of one or more ligaments.
Significant swelling and bruising
Walking may be extremely painful or impossible.
Marked ankle instability may occur.
Associated fractures or cartilage injuries need to be ruled out.
The grade of sprain helps determine the appropriate treatment and rehabilitation program.
What are the symptoms of an Ankle Sprain?
Common symptoms include:
Pain around the ankle
Swelling
Bruising
Difficulty walking
Painful ankle movements
Feeling of instability or give-way
Persistent give-way episodes after an ankle sprain may indicate chronic ankle instability and should not be ignored.
How is an Ankle Sprain diagnosed?
A) Clinical assessment:
Diagnosis begins with a detailed history and clinical examination.
Orthopaedic surgeon assesses:
How the injury occurred
Location of pain
Degree of swelling and bruising
Tenderness
Ankle movements
Ligament stability
Ability to bear weight
Neurovascular status
Associated injuries
B) X-Ray
X-ray is not required for every ankle sprain but that decision is taken by your orthopaedic surgeon.
It is usually recommended if a fracture is suspected.
Clinical examination and established criteria such as the Ottawa Ankle Rules can help determine whether an X-ray is required.
C) MRI:
MRI is not necessary for an uncomplicated acute ankle sprain.
It is recommended only when:
Suspected grade 3 ligament injury
A high ankle sprain is suspected
Suspected cartilage or osteochondral injury
A tendon injury is suspected
Chronic ankle instability develops leading to repeated sprains
What is the treatment of an ankle sprain?
The treatment of an ankle sprain depends on its severity, the ligaments involved and the patient's activity level.
RICE protocol is followed after the injury: Rest, Ice, Compression, Elevation
1. Rest
During the initial period of 2 weeks after injury:
Avoid activities that increase pain
Restrict walking to necessary purposes
Crutches or walker to be used if weight-bearing is painful
The purpose is to protect the injured ligament to allow gradual healing and recovery.
2. Ice application
- Cold compresses help reduce the pain and swelling during the early phase.
- Icepacks should be applied for short periods of 10 minutes with a protective cloth wrapped around it
3. Compression
Tying elastic crepe bandage helps in keeping the swelling in check.
Bandage should not be tied too tight to avoid issues with blood supply of the leg.
4. Elevation
Keeping the leg elevated over a couple of pillows (above heart level) helps in reducing the swelling by gravity.
Elevation should be maintained for maximum possible time.
Less swelling allows the injured ligaments to heal faster.
5. Early Movement
Complete immobilisation for a prolonged period is generally unnecessary for most ankle sprains.
Once the pain permits, controlled ankle movements and progressive weight-bearing are usually encouraged after your orthopaedic doctor’s assessment.
Early functional rehabilitation helps restore movement, strength and confidence.
How does the rehabilitation work after an Ankle Sprain?
Physiotherapy is one of the most important components of ankle sprain treatment.
A structured rehabilitation program typically includes four stages.
Stage 1: Restoring Movement
Gentle ankle and subtler joint movements
Calf stretching
Gradual weight-bearing
Stage 2: Restoring Strength
Calf strengthening
Resistance-band exercises
Peroneal muscle strengthening (lateral support)
Progressive functional exercises
Stage 3: Restoring Balance
Single-leg standing
Proprioception exercises
Balance-board exercises
Dynamic balance training
Stage 4: Returning to routine and sport
Activity and sport specific rehabilitation includes:
Jogging, running, jumping
Landing drills, cutting and pivoting
Acceleration and deceleration
Sport-specific movements
The decision to return to sport should be based on functional recovery rather than simply the number of days since injury.
How long does an Ankle Sprain take to heal?
Recovery duration depends on the severity of injury.
As a general guide:
Grade 1 sprain: approximately 1-2 weeks for routine activities, although athletes may require longer for full sports recovery.
Grade 2 sprain: around 4-6 weeks weeks.
Grade 3 sprain: may require 2-2.5 months.
High ankle sprain: approximately 3 months.
These are approximate timelines. An athlete should return to sport only after adequate recovery of strength, balance, range of motion and sport-specific function.
Is surgery needed for an Ankle Sprain?
The majority of acute ankle sprains do not require surgery.
Surgery is considered only when there is:
Persistent instability i.e. repeated sprains or sensation of giving way
Chronic ligament insufficiency on examination by doctor
Associated bone fracture or cartilage injury
Tendon injury requiring treatment
An unstable high ankle sprain
For patients with chronic lateral ankle instability, procedures such as anatomic ligament repair or reconstruction may be considered after appropriate assessment.
What happens if an Ankle Sprain is not treated properly on time?
An ankle sprain should not be dismissed as a minor injury, particularly in athletes.
Inadequate treatment or premature return to sports can result in:
Chronic ankle instability
which can have following possible outcomes
Recurrent ankle sprains
Persistent ankle pain
Loss of balance
Reduced athletic performance
Risk of cartilage damage or injury
Difficulty returning to previous activity levels
The goal of treatment is therefore not simply to make the pain disappear.
The goal is to restore normal ankle strength, stability, balance and confidence.
How can you prevent an Ankle Sprain?
The risk of ankle sprain and its recurrence can be definitely reduced. Follow these simple rules:
Seek timely treatment after an ankle injury and complete the rehabilitation
Perform regular balance exercises
Strengthen the calf and peroneal muscles
Improve landing mechanics in sports
Wear appropriate sports footwear
Use an ankle brace during high-risk sports
Warm up well before sports
Gradually increase the training intensity
Frequently Asked Questions (FAQs) about Ankle Sprain
Is an ankle sprain serious?
Most ankle sprains are not serious and can be treated without surgery. However, severe ligament injuries or associated fractures, cartilage injuries or syndesmotic injuries require appropriate assessment.
How long should I rest after an ankle sprain?
The duration of rest depends on the severity of the injury. Prolonged complete rest is generally unnecessary. Once pain allows, controlled movement, progressive weight-bearing and rehabilitation should begin.
Can an ankle sprain heal completely?
Yes. Most ankle sprains recover well with appropriate treatment and rehabilitation. However, inadequate rehabilitation increases the risk of recurrent sprains and chronic instability.
Can I play sports with an ankle sprain?
Returning to sport before adequate recovery increases the risk of re-injury. You should have near-normal range of motion, strength, balance and sport-specific function before returning to competitive activity.
Why does my ankle keep spraining?
Repeated ankle sprains may be caused by residual ligament laxity, weakness, poor balance or inadequate rehabilitation after the initial injury. This may result in chronic ankle instability.
Does every ankle sprain require an MRI?
No. Most ankle sprains can be diagnosed clinically. MRI is generally reserved for persistent symptoms, suspected associated injuries or situations where the diagnosis is uncertain.
Key Takeaways..
Ankle sprain is one of the commonest sports injuries
Ankle sprains range from mild ligament stretch to a complete ligament rupture
Most ankle sprains can be treated without surgery
Early protected movement and structured physiotherapy are important for recovery
Persistent pain or repeated ankle sprains should be evaluated by an orthopaedic sports specialist
Ankle Sprain Treatment at ArthroSports Clinic, Dadar, Mumbai
Dr.Ajinkya Achalare specialises in all kinds of sports injuries including an ankle sprain and has a rich experience of treating athletes and sports persons.
At ArthroSports Speciality Orthopaedic Clinic, Dadar, Mumbai, the approach to sports injuries focuses on accurate diagnosis, evidence-based treatment, rehabilitation and a safe return to an active lifestyle.
If you have persistent ankle pain, recurrent ankle sprains or a feeling of ankle instability after an injury, consult Dr. Ajinkya Achalare, an orthopaedic sports surgeon for an accurate evaluation, customised treatment and a complete recovery.
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