Ankle Sprain Care and Recovery

What You Need To Know

Understanding ankle sprains, why they happen, and how they are treated.

Understanding Ankle Sprains

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

Patients report pain after having twisted an ankle. This usually occurs due to an inversion injury, which means the foot rolls underneath the ankle or leg. It commonly occurs during sports. Patients will complain of pain on the outside of their ankle and various degrees of swelling and bleeding under the skin (i.e. bruising). Technically, this bruising is referred to as ecchymosis. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.

Evaluation typically begins with a physical examination of the ankle, checking for areas of tenderness, swelling, and range of motion. Imaging such as X-rays may be ordered to rule out a fracture, and in more severe cases an MRI can help assess the extent of ligament damage. Grading the sprain (mild, moderate, or severe) helps guide the appropriate course of care.

Anyone who cannot bear weight on the ankle, has significant swelling or bruising, or whose pain does not improve within a few days should be evaluated by a podiatrist. Early treatment helps reduce the risk of chronic instability and repeat injury, and starting care promptly gives the ligaments the best chance to heal properly.

Causes, Risk Factors, and Recovery

As noted, ankle sprains occur when the ankle is twisted underneath the leg, an action called inversion. Risk factors include activities such as basketball and other jumping sports, in which an athlete can come down on and turn the ankle or step on an opponent’s foot. Uneven walking surfaces, fatigue, and improper footwear can also contribute to a twist or roll of the ankle.

Some people are predisposed to ankle sprains. In people with a hindfoot varus, which means that the general nature or posture of the heels is slightly turned toward the inside, these injuries are more common. This is because it is easier to turn on the ankle. Those who have weak muscles, especially those called the peroneals which run along the outside of the ankle, may also be more predisposed.

In those who have had a severe sprain in the past, it is also easier to turn the ankle and cause a new sprain. Therefore, one of the risk factors of spraining the ankle is having instability. Repeat sprains can stretch the ligaments further over time, making the ankle feel as though it gives way during everyday activity.

Recovery from an ankle sprain often involves rest, ice, compression, and elevation (RICE) in the early days, followed by gradual return to activity. Physical therapy and strengthening of the peroneal muscles can help restore stability and reduce the chance of future sprains. With a thoughtful treatment plan and consistent follow-up, most patients return to their normal activities with a stronger, more stable ankle.