Ankle Sprains

What it is

An ankle sprain often results in stretching or tearing of the ligaments that connect the end of the lower leg bone to the foot. It is much more common to sprain the outside or lateral ankle, but can occur on the inside as well. More severe injuries can include involvement of the bones, joints surfaces of the ankle and foot, and tendons.

While most ankle sprains won't keep you out of action for long, we often see that even minor or moderate ankle sprains that haven't been managed well can still be problematic weeks or months later, and can greatly increase the chances of suffering another injury.

Sprain grades

Sprains are commonly graded by how much of the ligament is involved. The grade gives an indicaton how much activity is appropriate early on and how long recovery is likely to take.

• Grade I (mild) - the ligaments are stretched or slightly torn, with mild swelling and tenderness. Weight-bearing is usually possible.
• Grade II (moderate) - a partial tear, often more swelling, bruising and difficulty weight-bearing, and some loss of joint stability.
• Grade III (severe) - a complete tear, with significant swelling and bruising, marked instability and difficulty taking weight.

Grading is a guide, not a prognosis on its own. Two people with the same grade can present very differently, which is why we assess rather than assume.

Recovery timeframes

Mild or Grade I sprains typically take 1-3 weeks for a return to sport, moderate or Grade II sprains typically 3-6 weeks, and high or Grade III sprains anywhere from 4-12 weeks. All are dependent on your individual presentation and the presence or otherwise of any other complicating factors such as your past history or having joint or chondral involvement.

Do I need a scan or X-ray?

Most ankle sprains do not need imaging. We assess the ankle first to work out which structures are likely involved and the suspected severity of injury. Where the assessment suggests a fracture or a more significant injury may be present, we can refer you for imaging.

Having the nature and severity of your ankle injury assessed by a professional is what guides the best management, because every injury is unique.

Early management

Managing swelling

Minimising swelling early can make the rest of the recovery easier. We usually recommend Compression, Elevation, Relative rest and Ice - the C.E.R.I. principles - in the first days after injury.

Walking and weight-bearing

Early movement helps improve recovery in most cases, but the amount of activity needs to be suitable for the severity of the injury. Complete rest is rarely the best approach, and neither is pushing through. Part of the value of an early assessment is knowing which applies to you.

Rehabilitation

Regaining movement

Restoring full ankle range of motion while respecting healing tissues is a priority, and may involve exercises such as ankle "alphabet" drills and "knee to wall" stretching.

Regaining strength

Strength work covers both the big muscles, such as the calf, and the smaller balance and control muscles around the ankle. Calf raises and elastic resistance exercises are typical starting points.

Balance and proprioception

Your balance reactions and agility skills need to be working well before you return to sport. That usually progresses from stable single-leg balance, to wobble board type drills and balance with eyes closed. Agility work follows with ladder drills, jumping and hopping and sport specific drills.

This is the stage most commonly skipped as you may have minimal pain or soreness at this stage, and failing to regain this capacity is closely linked to the risk of spraining the same ankle again.

Bracing and taping

Well-fitting shoes and an ankle brace or taping can be valuable on return to training and games, particularly in the early weeks back and in court sports where the risk of rolling the ankle is highest.

Return to sport

We look for objective markers rather than just the absence of pain for a full return to sport: full range of motion, calf and ankle strength comparable to the other side, confident single-leg balance and control, and the ability to hop, land and change direction without hesitation. Where useful we use VALD ForceDecks hop and balance testing to measure how the injured side is performing compared to your other side.

Recurrent and chronic ankle instability

Repeatedly rolling the same ankle is one of the most common reasons people come to see us, often months or years after the original sprain. A first sprain that settled on its own but was never properly rehabilitated frequently leaves reduced balance reactions, weakness in the small stabilising muscles and a joint that may feel unreliable on uneven ground.

This is treatable, and the approach is the same in principle whether the sprain happened last week or three years ago: restore movement, rebuild strength and control, then retrain balance and agility until the ankle is dependable again.

High ankle sprains

A "high ankle sprain" involves the syndesmosis, the strong ligaments joining the two lower leg bones just above the ankle joint, rather than the ligaments on the outside of the ankle. These injuries are less common, but do happen and may occur when a twisting or rotational force was involved. These generally take considerably longer to settle than a standard ankle sprain. Early assessment is particularly worthwhile to monitor for high ankle involvement.

Related service: Sports Physiotherapy →

Related condition: Running Injuries →