Elite Foot & Ankle

Ankle Sprain

An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in. A sprain of one or more of the ligaments that hold the tibia and fibula together at the ankle. The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. Ligaments are tough bands of tissue that help connect bones together. They also keep the ankle from sliding forward and from rolling inward on its side.

The injury can occur when one rolls over a rock, lands off a curb, or steps in a small hole or crack in the road. Usually the sprain is only mild, but on occasion it may seriously injure the ligaments or tendons surrounding the ankle joint.

Most ankle sprains involving the ligaments are weight bearing injuries. When someone rolls their foot outward and the front of the foot points downwards as he or she lands on the ground, lateral ankle sprain can be a result. It is usually this situation that causes injury to the anterior talo-fibular ligament. However, when the foot rolls inwards and the forefoot turns outward, the ankle is subject to an injury involving the deltoid ligament that supports the inside of the ankle.

Causes of Ankle Sprains

The ligaments may be injured by a sharp, outward twisting of the foot and ankle. This can stretch the ligament, cause tears and, in severe cases, rupture. This injury often occurs in athletes involved in sports such as football, basketball and soccer.

A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.

The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.

Symptoms of Ankle Sprains

Initially the ankle is swollen, painful, and may become bruised. The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.

Diagnosis of Ankle Sprains

When assessing an ankle sprain, your podiatrist will want to know how you were injured plus the history of previous ankle sprains. Where the foot was located at the time of injury, “popping” sensations, whether the runner can put weight on the ankle are all important questions needing an answer. If past ankle sprains are part of the history, for example, a new acute ankle sprain can have a significant impact.

The diagnosis of an ankle sprain is usually made by examination of the ankle and X-rays to make sure that the ankle is not fractured. A physical examination is used to determine which ligament has been injured.

If a complete rupture of the ligaments is suspected, your doctor may order stress X-rays as well. These X-rays are taken while the ligaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.

X-rays help rule out fractures, “fleck fractures” inside the ankle joint, loose bodies, and/or degenerative joint disease (arthritis). Stress X-rays are taken when ligamentous rupture or ankle instability is suspected. When a stress test is taken of your ankle, don’t be surprised if the same test is performed on the other ankle. This is done to compare the two ankles, particularly in cases of ligamentous laxity (loose ligaments).


Nonsurgical Treatment

The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the word RICE. These stand for rest, ice, compression, and elevation.

  • Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle.
  • Ice: Applying ice can help ease pain and may reduce swelling.
  • Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap.
  • Elevation: Supporting your ankle above the level of your heart helps control swelling.

Depending on the degree of injury, a brace may be worn to support the ankle, but still allow weight bearing, are the most popular treatment for helping reduce strain on the healing tissues.
Healing of the ligaments usually takes about six weeks, but swelling may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength.


Surgeons will occasionally do procedures right away in athletes who tear a lateral ankle ligament. In most other cases of torn ankle ligaments, surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments.