Ankle sprains – Assessment and Treatment

Ankle sprains or “inversion injuries” are one of the most common injuries experienced by recreational and elite athletes, accounting for approximately 10-30% of all sports related injuries across a number of sports including soccer, netball, basketball and rugby.

How does an ankle sprain occur?

An ankle sprain generally occurs when the ankle “rolls” inwards, as a result of uneven playing surfaces, landing awkwardly following a jump or changing direction. The ligaments, tendons and joint capsule on the outside of the ankle are stretched beyond their capacity, causing injury.


Approximately 85% of all ankle sprains occur to the lateral ligament complex which is comprised of the anterior talofibular ligament (ATFL), joint capsule, calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL) (See picture below).

The ATFL is involved in the majority of lateral ankle sprains; the CFL in approximately 40% and the PTFL in less than 10% of all injuries.

How do I know if I have rolled or sprained my ankle?

Following an acute ankle sprain, pain is generally felt on the outside of your ankle which is often accompanied by immediate swelling, which can be localised to the ankle or present in the foot and toes depending on the severity of your injury. There is also often bruising or skin discolouration on the inside and/or outside of the foot, however this has not been shown to determine the severity of your injury or indicative of a fracture to one of the bones in your ankle or foot.

How do I know if it’s more serious than just a sprain?

The Ottawa ankle rules are accurate guidelines that are used by doctors and physiotherapists to determine whether or not an x-ray should be obtained following an ankle sprain. These guidelines include:

  • Younger than 16 OR older than 55 years of age (as their bones are softer)
  • Bone tenderness of the medial or lateral malleolus, navicular or base of the 5th metatarsal (pictured below)
  • Unable to weight bear immediately after the injury for 4 steps

Less than 15% of all ankle sprains result in a fracture, so if you suspect you may have suffered one see your doctor or physiotherapist for a thorough assessment and referral for an x-ray of your ankle or foot.

What’s the best early management of my ankle sprain?

Right after an ankle injury, the most important thing you can do is try to reduce your pain and inflammation as fast as possible. This is best achieved by following the PRICER protocol, which includes:

  • Protection – Avoid activities that may cause further damage or pain

  • Relative rest – Avoid activities that cause pain to the area but don’t avoid moving the ankle as this will slow the recovery process (let pain be your guide)

  • Ice – Apply an ice pack for 20 minutes every 1-2 hours for the first 72 hours

  • Compression – Apply a compression bandage to minimise and control swelling

  • Elevation – Elevate the ankle above the level of your heart

  • Referral – Medical assistance should be sought as soon as possible to determine the extent of the injury and develop a rehabilitation plan for full recovery return to sport.

Medications such as Panadol may also be necessary to control pain, however research suggests that anti-inflammatory medications should not be used within the first 72 hours as they can impact the normal inflammatory process which is essential for healing, we want to control the swelling, not stop it completely!

What will my rehabilitation consist of?

Adequate rehabilitation following an ankle sprain is very important. Recent studies have shown that not only do 30% of individuals who suffer ankle sprains end up with persistent symptoms such as pain and swelling but 20% also have recurrent episodes of ankle sprains, so rehabilitation is vital to not only reduce symptoms and return you to full function but also to prevent re-occurrence of future ankle sprains.

Physiotherapy will include a thorough assessment of your ankle and foot to determine what structures have been injured. Treatment can start on day 1 and will depend on the type of injury you have sustained but will normally include:

  • Management of pain and swelling (strapping/bracing)

  • Hands-on manual therapy in order to restore normal joint movement

  • An individually tailored rehabilitation program to restore flexibility, strength and proprioception (balance) as well as prevent future injuries

  • Sports specific exercises to ensure safe return to sport

  • Advice on how maintain your fitness throughout the rehabilitation process

How long will it take to recover?

Every ankle sprain is different and the recovery time and return to sport will vary depending on individual factors such as effective early management, the extent of the injury, previous history of injury and underlying flexibility, strength and proprioception issues. However, as a rough guide mild ankle sprains with minimal fibre damage generally take 2-4 weeks, moderate ankle sprains 4-6 weeks and severe ankle sprains with complete ligament ruptures and/or fractures 6-12 weeks for full recovery.

For any further information, please do not hesitate to contact us at Clinical Physio, St Ives


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