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Ankle Sprain – Causes, Symptoms & Treatment
An ankle sprain is an injury to the ligaments of the ankle joint caused by sudden twisting or rolling of the foot. It is one of the most common sports injuries.
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An ankle sprain is an injury to the ligaments of the ankle joint caused by sudden twisting or rolling of the foot. It is one of the most common sports injuries.
What is an Ankle Sprain?
An ankle sprain, medically referred to as a distortion of the ankle joint, is an injury to one or more ligaments surrounding the ankle. It occurs when the foot twists or rolls unexpectedly, causing the ligaments to stretch beyond their normal range. Depending on severity, the ligaments may be mildly overstretched, partially torn, or completely ruptured.
Causes
The most common cause is a sudden inward rolling of the foot, known as a supination trauma or inversion injury. Common triggers include:
- Sports activities, especially ball sports and running
- Walking or running on uneven surfaces
- Inappropriate or worn-out footwear
- Previous ankle injuries that have weakened joint stability
- Muscle weakness or poor coordination and balance
Symptoms
Symptoms of an ankle sprain vary depending on the severity of the ligament injury. Common signs include:
- Pain around the ankle, typically on the outer side
- Swelling and edema formation
- Bruising (hematoma) due to damaged blood vessels
- Limited range of motion and pain when bearing weight
- In severe cases: noticeable instability of the joint
Grades of Severity
Ankle ligament injuries are medically classified into three grades:
- Grade I: Mild overstretching of the ligaments without tearing; slight swelling and pain
- Grade II: Partial tear of one or more ligaments; moderate swelling and some instability
- Grade III: Complete rupture of a ligament; significant swelling, pain, and joint instability
Diagnosis
Diagnosis is primarily based on a clinical examination. The physician reviews the mechanism of injury and palpates the ankle to identify areas of tenderness and instability. If a fracture or more complex injury is suspected, imaging studies may be used:
- X-ray: To rule out bone fractures
- Ultrasound: To assess the integrity of the ligaments
- MRI (Magnetic Resonance Imaging): For unclear findings or suspected complex injuries involving cartilage or tendons
Treatment
Treatment depends on the grade of injury. For most ankle sprains, conservative management is effective. The RICE protocol (Rest, Ice, Compression, Elevation) is the recommended first-aid approach immediately after injury:
- Rest: Stop all activity and avoid weight-bearing
- Ice: Apply a cold pack to reduce pain and swelling (never directly on bare skin)
- Compression: Use a bandage or wrap to support the joint and limit swelling
- Elevation: Raise the foot above heart level to reduce fluid buildup
Conservative Treatment
For Grade I and Grade II injuries, treatment typically includes:
- Supportive bandages or ankle braces (orthoses)
- Anti-inflammatory pain medication such as ibuprofen or diclofenac
- Physiotherapy to restore strength, flexibility, and balance
Surgical Treatment
In cases of complete ligament rupture (Grade III) with persistent instability that does not respond to conservative measures, surgical ligament reconstruction may be considered. However, even in severe sprains, a conservative approach is often trialed first.
Rehabilitation and Prevention
Thorough rehabilitation after an ankle sprain is essential to restore full joint function and reduce the risk of re-injury. Physical therapy focuses on strengthening surrounding muscles and improving proprioception (the body's sense of joint position). Preventive strategies include:
- Wearing appropriate and supportive footwear
- Warming up adequately before physical activity
- Balance and coordination training exercises
- Using ankle braces during sports if instability is known
References
- Fong DT et al. - A systematic review on ankle injury and ankle sprain in sports. In: Sports Medicine, 2007;37(1):73-94. Available on PubMed.
- Kerkhoffs GM et al. - Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. In: British Journal of Sports Medicine, 2012;46(12):854-860.
- van den Bekerom MP et al. - What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? In: Journal of Athletic Training, 2012;47(4):435-443.
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