What is a Sprained Ankle?
A sprained ankle occurs when you overstretch your ankle ligaments. Ankle sprains vary in their severity. Mild “twisted ankle” or “rolled ankle” sprains, through to severe complete ligament ruptures. In extreme cases, avulsion fractures (minor attachment fractures) or fracture (significantly broken bones).
What Causes a Sprained Ankle?
Ankle sprains are over-stretched ligaments. Injuries can occur by simply rolling your ankle on some unstable ground. Common examples of this happen. Landing unbalanced from a jump, awkwardly planting your foot when running, or stepping onto an uneven surface can cause an ankle sprain.
What is Sprained Ankle Symptoms?
The mechanism of injury is a history of your ankle rolling. This description is the key ingredient to suspecting a sprained ankle. When rolled, you may hear a popping or cracking sound. Severe ankle pain, swelling, and bruising follow. Lateral or medial ligament sprains are locally tender over the injured ligament.
You may have trouble standing on your foot or walking, depending on the severity of your ankle sprain. A walking boot, crutches, or strapping may provide comfortable support to help you mobilise in these cases.
In more severe cases, sharp pain deep in the ankle joint can be associated with a talar dome fracture. Pain between your lower shin bones may be a syndesmosis or high ankle sprain. These injuries are far may disabling than a more moderate lower ankle sprain, and misdiagnosis can lead to premature ankle joint osteoarthritis and, potentially, ankle surgery.
How is a Sprained Ankle Diagnosed?
Your physiotherapist is highly skilled in the assessment and diagnosis of an ankle sprain. Your physiotherapist will listen to your injury history and perform a thorough clinical examination to determine the severity of your sprained ankle.
Your physio may refer you for additional diagnostic tests such as an X-ray or MRI if required. These tests will confirm or exclude specific ligament or bone injuries.
MRI – Sprained Ankle.
Which Ankle Ligaments Sprain?
Your ankle joint, which is known as the talocrural joint, is made up of three bones. Your tibia (shin bone; inside ankle bone), fibula (outer lower leg bone; outside ankle bone), and your talus (deep ankle bone). Beneath your talocrural joint lies the subtalar joint, articulating the talus and the calcaneus (heel bone). This forgotten joint is overlooked frequently during assessment, diagnosis and rehabilitation.
Your ankle ligaments attach bone-to-bone. They passively limit the motion available at each joint.
The ankle’s lateral ligaments are on the outside (lateral aspect), which are the most frequently injured in an ankle sprain. These include the:
- anterior talofibular ligament (ATFL)
- calcaneofibular ligament (CFL)
- posterior talofibular ligament (PTFL)
The main medial (inside of the ankle) ligament is the much stronger deltoid ligament.
High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries. Unfortunately, misdiagnosis is common.
Accurate Diagnosis is Important!
Sprained ankle treatment varies depending upon your diagnosis. The spectrum can range from a day or two of protection all the way through to surgical stabilisation. Luckily, most are mild to moderate, where early physiotherapy intervention can return you to life promptly. If you are unable to weight-bear pain-free, please seek a professional assessment.
Please seek the advice of your physiotherapist or a sports physician who has a particular interest in ankle injuries.
Sprained Ankle Treatment
Unfortunately, a sprained ankle can increase your risk of re-injury by as much as 40-70%, but the proper post-injury rehabilitation exercises significantly decrease the risk.
There are essential treatment aims that need to be covered to rehabilitate your sprained ankle and prevent a recurrence effectively.
Physiotherapy Treatment Aims
- Injury Protection, Pain Relief & Control Inflammation
- Regain Full Range of Motion
- Strengthen your Ankle and Calf Muscles
- Restore Joint Proprioception & Balance
- Restore Normal Function
- Speed & Agility
- Sport-Specific Skills
- Graduated Return to Training
- Return to Competition
Sprained Ankle Recovery Time
How long does it take for an ankle sprain to heal?
There is no specific time frame that sprained ankle recover. While we know ligaments themselves will take at least six weeks to heal, your muscle strength, range of motion, proprioception, and return to function can vary considerably. Here are some general guidelines.
Grade 1 – Mild
In mild cases, you can expect complete ligament healing within 2 to 3 weeks, but it will take at least six weeks for full scar tissue maturation.
Despite most people being told to “rest” and it will recover, we find that these mild sprains often result in joint stiffness, ligament laxity, muscle weakness or tightness, plus reduced proprioception (balance and joint awareness).
If not adequately treated, these often cause your ankle and foot joints to compensate for movement at adjacent joints, which can lead to several other injuries months or years down the track.
Grade 2 – Moderate
Grade 2 injuries occur when you have a significant ligament injury that allows the ligament to excessively stretch. In most cases, these injuries result in a recovery period of 4 to 6 weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive.
You should thoroughly rehabilitate all Grade 2 injuries to enable:
- full range of motion and strength
- full proprioception, power, and agility
- full return to sport-specific drills
Grade 3 – Severe
Grade 3 ligament injuries are when the ligament is completely ruptured. More severe ankle sprain injuries can also include fractures of the bones or high ankle sprains, which will require additional rehabilitation time to a simple lower ankle sprain.
A Grade 3 ankle sprain rehabilitation takes typically 6 to 12 weeks but is quite variable depending on your specific injury. Your physiotherapist or surgeon will be able to provide you with more specific guidelines and advice.
For more specific advice about your sprained ankle, please ask your physiotherapist.
What Happens If You Leave a Sprained Ankle Untreated?
While the sprained ligaments most commonly heal within 6 to 12 weeks, it is the functional disability that is important in the long-term for a sprained ankle.
Stiff ankles that do not regain their full-motion not only hamper your ability to descend stairs or point your toes, which may hinder your ability to swim or dance. Ideally, it would be best if you loosened stiff ankles to regain full range of motion.
Loose ankles will feel unstable and can render you susceptible to re-sprain and further ankle joint damage, which can increase your likelihood of degenerative arthritis. You can usually strengthen wobbly ankles to control your ankle dynamically. Weak ankles fall into a similar bracket.
There is rarely a simple ankle sprain that doesn’t have an ongoing functional impact. Professional rehabilitation guidance can accurately assess your ankle and promptly correct any deficits while the ankle injury is in the youthful tissue healing phase. Chronic ankle sprains are always harder to treat due to scar tissue stiffness, established muscle weakness, or reduced proprioception.
High ankle sprains involve ligament damage to the stabilising structures supporting your two weight-bearing shin bones (tibia and fibula). High ankle sprains are far more disabling ankle injuries. Sadly, often misdiagnosed as a simpler lower sprained ankle. Failure to treat an unstable high ankle sprain can quickly destroy your weight-bearing ankle joint surfaces and result in ankle joint destruction. Joint destruction will be both painful and functionally disabling. This often results in ankle/foot surgery to either fuse your ankle joint or total ankle joint replacement. Neither are perfect outcomes if prevention is an option.
For more specific advice about your sprained ankle, please consult your physiotherapist or foot healthcare specialist.
Sprained Ankle Treatment Progressions
There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation during your physiotherapist’s clinical assessment. In most cases, you’ll find that your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that your physiotherapist monitors each progression. Attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.
Phase 1 – Injury Protection: Pain Relief & Control Inflammation
As with most soft tissue injuries, the initial treatment is RICE – Rest, Ice, Compression and Elevation.
(Active) Rest: In the early phase, you’ll most likely be unable to walk on your sprained ankle. Your first aim is active rest from pain-provoking postures and movements. Active rest means that you should stop doing the action or activity that provokes ankle pain. In most cases, you will need to be non-weight-bearing. You may need to be placed in an ankle walking boot, a supportive ankle brace or utilise crutches.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Compression: A compression bandage, Tubigrip compression stocking or kinesiology supportive taping will help support the injured soft tissue and reduce excessive swelling.
Elevation: Elevating your injured ankle above your heart will assist gravity in reducing excessive swelling around your ankle.
Your physiotherapist will utilise a range of helpful tricks, including pain-relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase.
Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the first 48 to 72 hours to encourage additional bleeding. Most people can tolerate paracetamol as a pain reliever.
Phase 2: Regain Full Range of Motion
The torn ligaments will successfully reattach and heal a standard functional length if you protect your injured ankle ligaments appropriately. Mature scar formation takes at least six weeks. During this period, you should be aiming to optimally remould your scar tissue to allow for entire functional ankle movement and prevent a poorly formed scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage and exercises designed to address your joint range of motion, muscle length and normal neural tissue motion.
IMPORTANT: Researchers have identifies that the history of a sprained ankle predisposes you to a stiff ankle joint that further predisposes you to an array of injuries, including ankle sprains, foot pain, calf and leg injuries, plus back pain. Therefore, anyone who has suffered a sprained ankle should seek professional guidance to assess the amount of ankle joint motion you have. Don’t hesitate to get in touch with your physiotherapist for specific testing and advice.
Just as importantly, you should not overstretch ligaments and soft tissue, or you may develop a passively unstable ankle. Your physiotherapist will prescribe the exercises that are best suited to your needs.
Phase 3: Restore Muscle Strength
Your calf, ankle and foot muscles will require strengthening after an ankle sprain. It is essential to regain normal muscle strength to provide standard dynamic ankle control and function. Your strength and power should progress gradually. Weight-bearing progressions are from non-weight bear to partial, and then full weight bear and resistance loaded exercises. Depending on your assessment findings, you may also require strengthening your other leg, gluteal and lower core muscles.
Your physiotherapist will guide you.
Phase 4: Normalise Foot Biomechanics
Sprained ankles can occur from poor foot biomechanics, e.g. flat foot or high arch. Your physiotherapist should assess your foot arch and its control. In some instances, you may require a foot orthotic (shoe insert), or you may be a candidate for the Active Foot Posture Stabilisation Program.
Your physiotherapist will happily discuss the pros and cons of both options with you.
Phase 5: Restore High Speed, Power, Proprioception, and Agility
Most sprained ankle injuries occur during high-speed activities, which place enormous forces on your ankle and adjacent structures.
Your physiotherapist will guide you through exercises as you return to sport. They’ll address these essential rehabilitation components to improve your sporting performance and prevent a recurrence.
Depending on what your sport or lifestyle entails, a customised speed, agility, proprioception and power program will prepare you for light sport-specific training.
Phase 6: Return to Sport
If you play sport and depending on your chosen sport’s demands, you may require sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
Common Ankle Injuries
The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.
An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.
- Ankle Fracture (Broken Ankle)
- Stress Fracture
- Stress Fracture Feet
- Severs Disease
- Heel Spur
- Shin Splints
While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:
- Achilles Tendinopathy
- Achilles Tendon Rupture
- Peroneal Tendinopathy
- Tibialis Posterior Tendinopathy
- FHL Tendinopathy
- Plantar Fasciitis
Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?
Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.
- Anterior Ankle Impingement (Front of Ankle Pain)
- Posterior Ankle Impingement (Back of Ankle Pain)
- Pes Planus (Flat Feet)
- Tarsal Tunnel Syndrome