Ankle Sprains
An ankle sprain is one of the most common musculoskeletal injuries and occurs when the ligaments that support the ankle are stretched or torn. Most ankle sprains involve the ligaments on the outside (lateral aspect) of the ankle and typically happen during sports, exercise, or everyday activities such as walking on uneven ground. The majority of ankle sprains heal well with appropriate nonoperative treatment, though some severe injuries may require surgical intervention.
An ankle sprain usually occurs when the foot twists or rolls beyond its normal range of motion. Common mechanisms include:
- Rolling the ankle inward (inversion injury), which is the most frequent mechanism
- Landing awkwardly after a jump
- Sudden changes in direction during sports
- Stepping on an uneven surface
- Slipping or falling
Less commonly, the ankle may roll outward (eversion injury), which can affect the ligaments on the inside of the ankle.
The ankle joint is formed by three bones:
- Tibia (shin bone)
- Fibula (outer lower leg bone)
- Talus (ankle bone)
Ligaments are strong bands of tissue that connect bones and stabilize the joint. Key ankle ligaments include:
Lateral (outside) ligaments – most commonly injured:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
Medial (inside) ligament:
- Deltoid ligament (strong and less commonly injured)
Syndesmotic ligaments:
- Stabilize the tibia and fibula (“high ankle sprain”)
Symptoms vary depending on the severity of the injury and may include:
- Pain around the ankle, especially with weight bearing
- Swelling and inflammation
- Bruising or discoloration
- Tenderness to touch
- Limited range of motion
- A feeling of instability or the ankle “giving way”
- Difficulty walking or standing
Severe sprains may cause significant swelling and an inability to bear weigh
Initial management focuses on reducing pain and swelling and protecting the injured ligaments. This often includes:
- Rest: Avoid activities that worsen pain
- Ice: Apply ice for 15–20 minutes several times a day
- Compression: Use an elastic bandage, ankle wrap or brace.
- Elevation: Keep the ankle elevated above heart level when possible
- Pain control: Over-the-counter anti-inflammatory medications if appropriate
Early evaluation by a medical professional is important to rule out fractures or more severe ligament injuries.
Most ankle sprains are treated without surgery.
Indications for nonoperative treatment include:
- Mild to moderate ligament injuries
- Stable ankle joint on examination
- No associated fractures or tendon injuries
Nonoperative treatment may include:
- Functional bracing/boot or an ankle stirrup brace
- Short-term immobilization in a walking boot for more severe sprains
- Physical therapy to restore motion, strength, and balance
- Gradual return to activity and sports
- Proprioceptive and balance training to prevent reinjury
Surgery is rarely required for ankle sprains but may be considered in select cases.
Indications for surgery include:
- Severe ligament tears with persistent ankle instability
- Failure of extensive nonoperative treatment
- Recurrent ankle sprains due to chronic instability
- Associated injuries such as cartilage damage or tendon tears
- Certain high ankle (syndesmotic) injuries
Surgical procedures may include:
- Ligament repair or reconstruction
- Syndesmotic fixation
- Treatment of associated cartilage or tendon injuries
Nonoperative Outcomes:
- Most patients recover fully within weeks to months
- High rates of return to normal activities and sports
- Physical therapy reduces the risk of recurrent sprains
- Some patients may develop chronic ankle instability if rehabilitation is incomplete
Operative Outcomes:
- Generally good outcomes in appropriately selected patients
- Improved ankle stability and function
- Longer recovery time compared to nonoperative care
- Small risks of complications such as stiffness, nerve irritation, or infection
Ankle sprains are common injuries that usually heal well with proper treatment. Early care, appropriate rehabilitation, and gradual return to activity are key to recovery and preventing reinjury. Most ankle sprains can be managed without surgery, while surgical treatment is
reserved for severe or persistent cases. With appropriate management, the majority of patients can expect a good outcome and return to their usual activities.
At a Glance
Dr. Hasani Swindell
- Fellowship-Trained Sports Medicine Specialist
- Board-Certified Orthopedic Surgeon
- Summa Cum Laude Graduate from the University of Pittsburgh
- Medical Degree from Columbia University
- Learn more
