Ankle Sprain

What tears: Usually the ligaments on the outer side, when the foot rolls inwards.
What matters most: Moving early, then balance training. Not rest alone.
The real risk: A second sprain. Most happen to ankles that never fully rehabilitated.

The ankle from the outer side, with the lateral ligaments running from the fibula to the foot shown torn. — The ligaments on the outer side run from the lower end of the fibula to the bones of the foot. These are what tear when the ankle rolls inwards.

The foot rolling inwards stretches the outer side of the joint. The ligaments there are short and thin compared with those on the inner side, which is why the outer ones give way first and why nearly every sprain happens this way round.

Torn is not the same as needing repair. Ligaments heal, and the question is whether they heal tight enough. That is decided by what happens over the following weeks, not by the moment of the injury.

How bad is it?

Sprains are graded by how much of the ligament has gone. The grade guides how long recovery takes, though it matters less than what you do during it.

	Grade I	Grade II	Grade III
The ligament	Stretched, not torn	Partly torn	Completely torn
Swelling	Mild	Moderate, with bruising	Marked, often immediate
Walking	Uncomfortable but possible	Painful, often limping	Usually not possible at first
Stability	Ankle feels stable	Some looseness	Clearly unstable
Typical recovery	One to three weeks	Three to six weeks	Several months

Grade III does not usually mean surgery. Even a completely torn ligament is generally treated with a period of protection and then rehabilitation. Surgery is for the ankle that stays unstable afterwards, not for the tear itself.

Does it need an X-ray?

Most do not. An X-ray is worth having if either of these applies:

You could not take four steps immediately after the injury, or cannot now
Pressing on the bone at the back of either ankle bone is sharply painful, or on the bone on the outer edge of the midfoot

Otherwise the ankle is assessed on how it behaves, and imaging is kept for the ones that do not follow the expected course.

The first two weeks

Days one to three

Protect it, ice it, and keep it elevated when you can. Put weight through it as comfort allows — using crutches to walk normally is better than hopping or avoiding it altogether.

The first week

Gentle movement in all directions, several times a day. Early motion reduces stiffness and speeds recovery; complete rest does the opposite.

Week two onwards

Strength work for the muscles on the outside of the ankle, and balance training — standing on one leg, then with eyes closed, then on an unstable surface. This is the part that prevents the next one.

Returning to sport

Not by the calendar. Hop, land, turn and sprint without pain or hesitation first. A brace or taping for the first season back is sensible after a significant sprain.

Why balance training, rather than just strength? A sprain damages the nerve endings in the ligament that tell your brain where the ankle is. Retraining that sense is what stops the foot rolling again on uneven ground, and it is the step most people skip.

When it is more than a sprain

If the ankle is still painful or swollen at six weeks, something else usually happened at the same time. See ankle pain for the wider picture.

A small fracture that did not show on the first X-ray
Damage to the cartilage on the top of the talus
A tendon tear behind the outer ankle bone
A high sprain, above the joint, which takes considerably longer and sometimes needs fixing

Ankle sprain treatment for the ankle that keeps giving way

Roughly a third of people have ongoing symptoms after a significant sprain. That is not something to live with.

A full rehabilitation programme first, since many unstable ankles are simply under-rehabilitated ones
A brace for sport while strength and balance improve
Ligament reconstruction where the ankle remains unstable despite proper rehabilitation — a reliable operation with a good record

Your surgeon

Ankle injuries here are seen by Dr Jeffrey Tan Gek Meng, an orthopaedic surgeon whose subspecialty is foot and ankle. He also treats sports injuries and lower limb trauma, and consults in English, Mandarin and Hokkien.

When to see someone about it

You cannot put weight on it, or could not at the time
It is no better after two weeks, or still swollen at six
It has given way again, or you no longer trust it
This is not the first time — repeated sprains are worth stopping
You need to return to a sport that involves turning and landing

Common questions

Should I rest it or walk on it?

Walk on it as comfort allows, using support if needed. Early movement and weight bearing produce a better result than resting completely, which leaves the ankle stiff and weak.

How long until I can play sport again?

It depends on the grade and on what you can do, not on the date. Hop, land, turn and sprint comfortably first. Mild sprains may take two weeks; severe ones take months.

Do I need a brace?

For the first weeks it helps, and for a season of sport after a significant sprain it reduces the chance of another. It is not a substitute for balance training.

Why does my ankle keep rolling?

Usually because the ligaments healed loose, the muscles are weak, or the sense of joint position never recovered. All three are treatable, and worth treating, since repeated sprains cause arthritis later.

Is a torn ligament an operation?

Usually not. Even complete tears are generally treated without surgery. An operation is considered when the ankle stays unstable after proper rehabilitation.

Do I need a referral to see an ankle sprain doctor?

No. Bring any X-ray reports, and be ready to describe how the ankle rolled and how many times it has happened.

Related conditions

Ankle pain · Foot pain · Knee pain · Osteoporosis