Ankle Sprain Explained
Ankle Sprain vs Ankle Injury
An ankle sprain is one of the most common musculoskeletal injuries, affecting athletes and non-athletes alike. Whether you’ve twisted your ankle walking on uneven ground or suffered a sports-related injury, understanding how to properly manage a sprained ankle is essential for a full recovery.
Ankle sprains are the most common type of ankle injury. Ankle injuries are the most common of all sporting injuries, comprising up to 45% of all injuries. It is also considered one of the most common injuries outside of sport. Most people have either experienced or know someone who has experienced an ankle sprain or injury at some stage.
Ankle sprains can be quite debilitating depending on the severity. They can interfere with daily life and general walking. The most common risk factor for an ankle sprain is previous history of an ankle sprain. Hence, it’s imperative that management of an ankle sprain is conducted by an experienced professional who can ensure proper rehabilitation is undertaken. This is where our podiatrists can help.
Looking for an Adelaide Podiatrist to help treat and prevent ankle sprains?
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What is an Ankle Sprain?
An ankle sprain occurs when the ligaments that support the ankle are stretched or torn due to excessive force. Ligaments connect bones to each other and provide stability to the joint. Most sprains happen when the foot twists inward (inversion), damaging the ligaments on the outside of the ankle.
In severe cases, a ligament can pull a small piece of bone away—a condition called an avulsion fracture.
Ankle sprains can vary in severity from a mild “twisted ankle” or “rolled ankle” to severe complete ligament ruptures, avulsion fractures or broken bones.
Ankle Sprain vs Ankle Injury: What’s the Difference?
While all ankle sprains are ankle injuries, not all ankle injuries are sprains. An ankle injury may also include fractures or tendon damage. However, ankle sprains are the most common type – accounting for up to 45% of all sports-related injuries and a significant portion of non-sport injuries.
What Causes an Ankle Sprain?
The most common causes of ankle sprains include:
- Sudden changes in direction during sports (e.g. football, basketball, soccer, netball, tennis)
- Walking or running on uneven surfaces (e.g. rocky terrain)
- Tripping or falling
- Landing awkwardly from a jump
- Stepping on someone else’s foot
The inversion sprain (foot rolling outward) is the most typical mechanism of injury. Most sprains occur on the outside of the foot. For this type of sprain to occur, stress is placed on a foot that is rolled outwards. This is also known as an inversion ankle sprain because the foot is in a medically described inverted position (supinated) when the injury occurs. The extreme force causes damage to the outside (lateral) ligament structures.
What are the Symptoms of a Sprained Ankle?
Common signs of an ankle sprain include:
- Sharp or throbbing ankle pain
- Swelling around the joint
- Bruising and discoloration
- Tenderness to touch
- Limited range of motion
- Instability or feeling of the ankle “giving way”
Looking for an Adelaide Podiatrist to help treat and prevent ankle sprains?
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Grading the Severity of an Ankle Sprain
From assessing the ligaments damaged through objective measures and imaging, we can grade ankle sprains from 1-3 depending on the severity. If your sprain does require imaging, it is normally an ultrasound, but sometimes requires both an x-ray and ultrasound. Ankle sprains are generally classified into three grades based on severity:
- Grade 1 (Mild): Slight stretching or microscopic tearing of the ligament. Mild swelling and discomfort.
- Grade 2 (Moderate): Partial ligament tear with noticeable swelling, bruising, and pain. Limping is common.
- Grade 3 (Severe): Complete ligament rupture. Severe pain, swelling, bruising, and difficulty bearing weight.
What to Do Immediately After an Ankle Sprain
If you suspect a sprain, follow the R.I.C.E. method during the first 48–72 hours:
- Rest: Avoid putting weight on the injured ankle. This is common sense as to avoid any further injury to the affected structures. Do not walk on it if it is painful.
- Ice: Apply for 15–20 minutes every few hours to reduce swelling. DO NOT use heat in the first 3 days
- Compression: A compressive dressing or bandages further limits the swelling caused by the release of fluids from damaged capillaries into the tissue and helps prevent bruising.
- Elevation: Raise the ankle above heart level to assist drainage of excess fluid.
The next phase of ankle sprain is the sub-acute phase. This is when the body shifts from inflammation to the proliferative stage which is characterised by new collagen and capillary formation. This phase generally starts around days 4 – 15.
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Ankle Sprain Recovery: Phases and Timeline
1. Acute Phase (Days 1–6)
Focus: Reduce pain and inflammation.
- RICE
- Gentle non-weight bearing movements (e.g., ankle alphabet)
2. Sub-Acute Phase (Days 4–15)
In the sub-acute phase, the prime focus is functional rehabilitation with therapeutic exercises that our Podiatrists can assist you with. These exercises will help build strength through the ankle and the affected ligament and will regain the stability needed to get you back to activities or sport. This phase is the most important part of the process.
If we don’t properly rehabilitate the damaged ligament, then you are much more likely to have another ankle sprain. Subsequent ankle sprains will likely result in a worse grade, meaning more pain and more time out of sport or activities. Actively rehabilitating the ligament and ankle is crucial for long term recovery and confidence.
The therapeutic exercises will help to restore the range of motion, strength and sensorimotor functions.
- Light stretching (e.g., seated calf stretch)
- Gentle mobilisation
- Begin isometric strengthening
3. Rehabilitation Phase
Focus: Restore function and prevent re-injury.
- Resistance band exercises (dorsiflexion, plantarflexion, inversion, eversion)
- Balance and proprioception training (e.g., wobble board)
- Return-to-activity exercises (jogging, agility drills)
Looking for an Adelaide Podiatrist to help treat and prevent ankle sprains?
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What exercises will I need to do?
Best Exercises for Ankle Sprain Rehabilitation
To regain full ankle function, incorporate the following:
- Range of Motion: Ankle circles, alphabet exercise. Range of motion must be regained before functional rehabilitation is initiated. Active but gentle ankle range of motion exercises can be initiated when pain tolerance will allow. This will help to keep the ankle moving and prevent it from becoming further restricted. Suggested exercises are the alphabet, using your ankle as a pen and drawing the alphabet. This simple exercise takes the ankle through all the ranges of motion and shouldn’t be too painful as it is non-weight bearing.
- Stretching: Calf and Achilles stretches. Stretching of the calf muscles should be initiated within 48 – 72 hours post injury. If weight bearing is an issue, you can do a seated calf stretch. It has been found that the achilles tendon has a tendency to contract after trauma. Stretching can help to reduce this contraction.
- Strengthening: Isometric and resistance band exercises. Normally, we will begin with isometric exercises performed against an immovable object going through the four movements of the ankle: dorsiflexion, plantarflexion, inversion and eversion. Progression is then made to dynamic resistance exercises, performing similar movements but this time against resistance using various objects and/or rubber resistance bands. Other exercises may involve toe walking, heel walking, toe curls and toe raises to regain strength and coordination.
- Balance Training: Wobble board, single-leg stands. Proprioceptive balance training can be initiated once full weight bearing without pain can be achieved. This training helps with the recovery of balance and postural control. The simplest device to use is a wobble board, which can be progressed using varied visual input and support conditions. Lack of variability in speed and intensity is a common mistake when performing proprioception and balance exercises. This variability can also be achieved through walking on varied surfaces, such as hard floors, uneven carpet, stairs and even the use of foam cushions.
- Sport-Specific Drills: Cutting, pivoting, and directional changes.
When walking and balancing is no longer limited by pain, we can progress to:
- Functional exercises on varied surfaces e.g. catching or hitting a ball
- 50% walking and 50% jogging forwards, backwards and in patterns. With progression towards 100% running.
Mobilisation
After an ankle sprain the talus and fibula can become restricted, contributing to a reduction in ankle range of motion. Through mobilisation and releasing through muscles, we can improve the ankle range of motion.
Looking for an Adelaide Podiatrist to help treat and prevent ankle sprains?
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When can I return to sport?
Your podiatrist can assess whether you are able to return to sport through a series of functional tests. A passing grade is seen as the injured limb performing at least 80% of the non injured leg.
Pain, swelling and joint range of motion are not reliable indicators of returning to sport. The limb needs to be functional, and that may not occur even if pain and swelling is reduced and joint range of motion improved.
How Can Ankle Sprains Be Prevented?
Proper rehabilitation is crucial to avoid future ankle injury. This involves:
- Appropriate management following the injury
- Restoration of normal joint range of motion
- Restoration of normal function and strength
- Use of proper footwear
- Functional orthotic control to help address unstable foot mechanics. Hypermobile feet and high arched feet with a rigid forefoot valgus can be a major contributor to ankle instability. Sometimes orthotic supports are utilised to improve stability and prevent excessive rolling of the foot and ankle.
Need Help with an Ankle Sprain in Adelaide?
If you’re dealing with an ankle sprain or want to prevent future injuries, our experienced Adelaide podiatrists are here to help. We offer comprehensive assessments, individualised rehabilitation plans, footwear advice and orthotic support tailored to your needs.
Looking for an Adelaide Podiatrist to help treat and prevent ankle sprains?
BOOK ONLINE or Call 8362 5900 to schedule an appointment time to suit.
