Ankle Sprain

Symptoms

• Pain and swelling on the outside of the ankle
• Bruising that may spread toward the toes
• Pain with walking or turning the foot
• A feeling that the ankle is loose or gives way

Causes and who gets it

Most sprains happen when the foot rolls inward while landing, cutting, or stepping on uneven ground. Basketball, volleyball, soccer, pickleball, and trail running are common culprits. A previous sprain is the biggest risk factor for another one.

How it is diagnosed

A clinician examines the ligaments and checks for a fracture. The Ottawa Ankle Rules help decide who needs an X-ray: pain near the ankle bones plus bone tenderness at specific spots, or being unable to take four steps. High ankle (syndesmotic) sprains are less common but take longer to heal and are worth identifying early.

Treatment

• Short-term protection: a brace or wrap, and crutches if walking is very painful
• Early, gentle movement and walking as pain allows usually beats prolonged rest
• Balance and strengthening exercises are the most important step for preventing re-injury
• A lace-up or stirrup brace during sport for several months after the injury
• Surgery is rarely needed and is reserved for severe or repeated instability

Recovery time

Mild sprains often feel better in 1 to 2 weeks. Moderate sprains commonly take 3 to 6 weeks. Severe sprains and high ankle sprains can take 2 to 3 months or longer. Ligaments keep remodeling after the pain is gone, so keep up balance work.

When to see a doctor

• You cannot put weight on the foot or take four steps
• Pain is directly over a bone
• The ankle or foot looks deformed, or is numb, cold, or pale
• Pain is above the ankle or in the shin after a twisting injury
• The ankle keeps giving way weeks later

Clinical pearls

• Apply the Ottawa Ankle Rules; check the base of the 5th metatarsal and the navicular
• Squeeze and external rotation stress tests screen for syndesmotic injury; consider stress views or MRI if positive
• Anterior drawer and talar tilt assess ATFL and CFL integrity, ideally a few days after the acute swelling settles
• Functional rehabilitation (early weight bearing, proprioceptive training) is preferred over immobilization for most lateral sprains
• Persistent symptoms past 6 weeks: think osteochondral lesion of the talus, peroneal tendon injury, or fracture of the lateral process of the talus or anterior process of the calcaneus