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Sprained Ankle

Updated: Jul 3, 2023

What is a Sprained Ankle?

A sprained ankle occurs when you overstretch your ankle ligaments. Ankle sprains vary in their severity, and are commonly referred to as “twisted ankle” or “rolled ankle”. In extreme cases, avulsion fractures (minor attachment fractures) or fracture (significantly broken bones).

What Causes a Sprained Ankle?

Ankle sprains are over-stretched ligaments. Injuries can occur by simply rolling your ankle on some unstable ground. Common examples of this happen are: landing unbalanced from a jump, awkwardly planting your foot when running, or stepping onto an uneven surface.

What Are The Symptoms of a Sprained Ankle ?

The mechanism of injury is usually to the lateral ankle. Most commonly, the sprain occurs during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear. This description is the key ingredient to suspecting a sprained ankle. When rolled, you may hear a popping or cracking sound. Severe ankle pain, swelling, and bruising follow within 48 hours, depending on severity. Lateral or medial ligament sprains are locally tender over the injured ligament. The ankle usually presents with extreme trouble standing on the foot or walking, depending on the severity of your ankle sprain. A walking boot, crutches, or strapping may provide comfortable support to help you mobilise in these cases.

In more severe cases, sharp pain deep in the ankle joint can be associated with a talar dome fracture. Pain between your lower shin bones may be a syndesmosis or high ankle sprain. These injuries are far may disabling than a more moderate lower ankle sprain, and misdiagnosis can lead to premature ankle joint osteoarthritis and, potentially, ankle surgery.

How is a Sprained Ankle Diagnosed?

A Sport Rehabilitator is highly skilled in the assessment and diagnosis of an ankle sprain, and will listen to the injury history and perform a thorough clinical examination to determine the severity of the sprained ankle. A Sport Rehabilitator may refer you for additional diagnostic tests such as an X-ray or MRI if required. These tests will confirm or exclude specific ligament or bone injuries.

Which Ankle Ligaments Sprain?

The ankle joint, which is known as the talocrural joint, is made up of three bones. Your tibia (shin bone; inside ankle bone), fibula (outer lower leg bone; outside ankle bone), and your talus (deep ankle bone). Beneath your talocrural joint lies the subtalar joint, articulating the talus and the calcaneus (heel bone). This forgotten joint is overlooked frequently during assessment, diagnosis and rehabilitation. Your ankle ligaments attach bone-to-bone. They passively limit the motion available at each joint.

The ankle’s lateral ligaments are on the outside (lateral aspect), which are the most frequently injured in an ankle sprain. These include the:

  • anterior talofibular ligament (ATFL)

  • calcaneofibular ligament (CFL)

  • posterior talofibular ligament (PTFL)

The main medial (inside of the ankle) ligament is the much stronger deltoid ligament.

High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries. Unfortunately, misdiagnosis in ankle sprain assessment is common.

Sprained Ankle Treatment

A sprained ankle can increase your risk of re-injury by as much as 40-70%, but the proper post-injury rehabilitation exercises significantly decrease the risk. There are essential treatment aims that need to be covered to rehabilitate a sprained ankle and prevent a recurrence effectively.

Rehabilitation Aims:

  • Injury Protection, Pain Relief & Control Inflammation

  • Regain Full Range of Motion

  • Strengthen your Ankle and Calf Muscles

  • Restore Joint Proprioception & Balance

  • Restore Normal Function

  • Speed & Agility

  • Sport-Specific Skills

  • Graduated Return to Training

  • Return to Competition

Sprained Ankle Recovery Time

How long does it take for an ankle sprain to heal?

There is no specific time frame for a sprained ankle recover within, each person is slightly different. While we know ligaments themselves will take at least six weeks to heal, your muscle strength, range of motion, proprioception, and return to function can vary considerably, especially with people trying different treatment modalities.

Grade 1 – Mild

In mild cases, you can expect complete ligament healing within 2 to 3 weeks, but it will take at least six weeks for full scar tissue maturation. Despite most people being told to “rest” and it will recover, we find that these mild sprains often result in joint stiffness, ligament laxity, muscle weakness or tightness, plus reduced proprioception (balance and joint awareness). If not adequately treated, these often cause your ankle and foot joints to compensate for movement at adjacent joints, which can lead to several other injuries months or years down the track.

Grade 2 – Moderate

Grade 2 injuries occur when you have a significant ligament injury that allows the ligament to excessively stretch. In most cases, these injuries result in a recovery period of 4 to 6 weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive. You should thoroughly rehabilitate all Grade 2 injuries to enable:

  • full range of motion and strength

  • full proprioception, power, and agility

  • full return to sport-specific drills

Grade 3 – Severe

Grade 3 ligament injuries are when the ligament is completely ruptured. More severe ankle sprain injuries can also include fractures of the bones or high ankle sprains, which will require additional rehabilitation time to a simple lower ankle sprain. A Grade 3 ankle sprain rehabilitation takes typically 6 to 12 weeks but is quite variable depending on your specific injury. Your Sport Rehabilitator, ankle consultant or surgeon will be able to provide you with more specific guidelines and advice.


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