Ankle sprains are common injuries that are often under treated, as they are sometimes assumed to be more minor than they really are. Common during certain sports that require a lot of lateral movement (like basketball and football), or when walking surface conditions are uneven or slippery, the ankle sprain can be a source of significant disability if improperly treated.

The ankle joint itself is the attachment of the foot to the leg, and is special in how it transfers the motion of the leg 90 degrees into the motion of the foot. The ankle naturally moves in an up and down direction, but does have some motion possible from side to side or inward and outward. When some force acts on the ankle that exceeds the natural motion of the ankle in a inward or outward direction (like when the foot rolls off a curb or in a pothole, or when an athlete come crashing down on it), the tissue will stretch. If this force is too strong, the tissue will actually tear. This injury can tear the tissue partially, or it can tear the tissue completely. These tissues that surround the sides of the ankle joint are called ligaments. On the outside of the ankle, there are three separate ligaments: one toward the front of the ankle, one along the side, and one towards the back. These ligaments connect the outermost bone prominence of the ankle to one of the bones of the back of the foot. Most people roll their ankle inward during an injury. This motion stretches and tears the ligaments on the outside of the ankle. Usually the first one or two ligaments are injured in a sprain, although severe sprains can involve the final ligament near the back. Sprains in which the ankle rolls outward are uncommon. The inside of the ankle is held by a very strong ligament structure that acts as a single unit. It is difficult to sprain this side of the ankle due to the strength of the ligament, and therefore sprains on this side do not occur with great frequency.


Ankle sprain symptoms include swelling, warmth, bruising, and of course pain following the injury. These symptoms do not necessarily show up at the exact time of the injury. In some cases, the symptoms can be delayed by a few hours. Additionally, a feeling of ankle weakness is also common, due to extra laxity of the ankle joint developing from the ligament tearing. Pain with standing or walking is to be expected. Severe pain in which one cannot even place the foot down without excruciating pain likely indicates a major fracture in the ankle or foot. The same is true for any sprain in which the ankle looks deformed or is angled off to one side. Several smaller foot fractures have been associated with ankle sprains, which do not necessarily add to the pain of a typical sprain directly. These often go untreated as people assume the pain was solely due to the sprain itself. In essence, a medical evaluation with foot and ankle x-rays is needed for all severe sprains, and most moderate sprains as well.


Treatment of any sprain begins with the usual formula of rest, ice, compression, and elevation. This treatment is often called 'RICE' as an acronym. These measures are designed to limit inflammation, a natural process the body uses to respond to injury, but one that can cause significant discomfort. Rest obviously helps the body to heal, and limits continued injury when one continues to walk or be active on an injured body part. The more a person walks on a sprain immediately following the injury, the more frayed and damaged the ligament s can get, furthering the injury itself. Icing, compression, and elevation reduces inflammation. By reducing inflammation, one can lower the amount of pain felt during this injury. It does not necessarily increase the body's ability to return to activity sooner, but can make the recovery period more comfortable. The ankle still needs support in order to heal, even if pain is minimal. The use of an ACE bandage or a stretchable ankle sleeve is helpful for very low grade sprains. All these steps alone are fine for minimal sprains that are not sore after a few days to a week following the injury. When a sprain is moderate to severe, these steps should be the initial part of a longer line of treatment. A medical evaluation, including x-rays, should be done to identify any significant instability, as well as any small fractures that may involve the bones surrounding the injury site. Further tests may need to be done if a full ligament tear is suspected, including the use of an MRI scan. Additional treatment measures can be employed beyond the initial four steps. This will likely include the use of medical grade removable braces or a walking boot to provide greater support for healing tissues. Certain sprains may require physical therapy eventually to prevent stiffening of motion and improve stability by helping the body adjust to the injury. Ankle sensation perception may need to be changed to accommodate the increased instability, and expert training can help the body to modify itself to prevent repeat spraining. In certain cases, especially with fractures, the use of a below-knee cast may be necessary to completely lock the ankle into a held position. Likewise, surgery is sometimes indicated to repair ligament tears or fractures.


The long term complications that can occur with an untreated or under treated ankle sprain include instability, pain or stiffness in the ankle joint, ankle arthritis, and frequent spraining due to the inherent weakness of the injured ankle tissue. These symptoms can last a lifetime, and can make even simple walking difficult, especially on uneven surfaces. Unstable ankles can be repaired surgically, with repair or replacement of the torn and frayed ligaments causing the instability. Alternately, long term ankle braces can be used in those who cannot or will not have surgery. Proper initial treatment can help prevent these complications, and lead to a lifetime of healthy ankle function.