Sprained Ankle

Senior Consultant Orthopaedic Surgeon

A sprained ankle occurs when the supporting ligaments stretch beyond their limits and tear. These ligaments stabilise the ankle joint by connecting bones. When a sprain happens, the ankle may become swollen, painful, and unstable. Most sprains heal with rest and rehabilitation, though severe cases may require medical intervention, including surgery. Ankle sprains often occur during physical activities when the foot twists, rolls, or turns beyond its normal range of motion.

Symptoms of a Sprained Ankle

People with ankle sprains may experience various symptoms depending on the severity of the injury and the ligaments affected.

Discomfort ranges from mild tenderness to severe, debilitating pain that makes weight-bearing impossible. Pain typically increases with movement or when pressure is applied to the injured area.

Fluid accumulates around the damaged ligaments, causing visible enlargement of the ankle. Swelling usually begins within minutes of the injury and may continue to worsen over 24–48 hours.

Damaged blood vessels leak blood into surrounding tissues, creating discolouration that may appear red initially before turning purple or blue. Bruising typically develops within 24–48 hours.

Stiffness and restricted range of motion affect the ankle joint due to pain, swelling, and instability. This can range from slight difficulty with certain movements to a complete inability to move the ankle.

The ankle may feel wobbly or give way, particularly when bearing weight or walking on uneven surfaces. This occurs because damaged ligaments cannot properly support the joint.

Some people report hearing or feeling a pop at the moment of injury. This may indicate a complete tear of one or more ligaments.

Causes and Risk Factors

Ankle sprains occur when the foot twists, turns, or rolls beyond its normal range of motion, stretching or tearing the ligaments that hold the ankle bones together.

Sudden direction changes

Quick pivoting or abrupt changes in direction during running or walking can push the ankle beyond its normal range. This commonly happens in sports like football, basketball, and tennis, where rapid directional shifts are frequent.

Uneven surfaces

Walking or running on irregular terrain increases the risk of the foot rolling inward or outward. Stepping in a hole, off a curb unexpectedly, or navigating rocky trails can put the ankle in a vulnerable position.

Previous ankle injuries

A history of ankle sprains increases the risk of reinjury. Once ligaments are stretched or torn, they may heal in a lengthened position, reducing joint stability.

Poor footwear

Shoes that lack adequate support or are unsuitable for certain activities can contribute to ankle instability. High heels, worn-out athletic shoes, or footwear without ankle support increase the risk of sprains.

Weak ankle muscles

Insufficient strength in the muscles surrounding the ankle joint reduces stability and protection. Underdeveloped ankle and foot muscles provide less muscular support during unexpected movements.

Medical conditions

Certain conditions affecting muscle control, balance, or joint stability can increase the likelihood of sprains. Peripheral neuropathy, obesity, and some neuromuscular disorders may contribute to a higher risk of ankle injuries.

Types of Ankle Sprains

Lateral (inversion) sprains

The foot rolls inward, stretching or tearing the ligaments on the outer ankle. These sprains often involve the anterior talofibular ligament, which is more susceptible to injury due to its weaker structure.

Medial (eversion) sprains

The foot rolls outward, damaging the strong deltoid ligament on the inner ankle. These are less common because the deltoid ligament provides greater stability and typically occur due to high-impact trauma.

Syndesmotic (high) sprains

Also called “high ankle sprains”, these involve the ligaments connecting the tibia and fibula above the ankle joint. They usually result from excessive upward foot motion or external rotation and take longer to heal than standard ankle sprains.

Diagnostic Methods

Physical examination

The doctor assesses pain, swelling, and bruising to identify injured ligaments. They check for tenderness along ligament pathways and evaluate stability by carefully moving the ankle in different directions. Tests for strength and range of motion may also be performed.

Ottawa Ankle Rules

This clinical tool helps determine whether X-rays are necessary by assessing pain in specific areas and the ability to bear weight. It reduces unnecessary radiation exposure while helping to detect fractures.

X-rays

Used to rule out fractures that may cause similar symptoms to sprains. While X-rays do not show ligaments, they can reveal indirect signs of severe sprains, such as small bone fragments where ligaments have torn from their attachment points.

Treatment Options

Ankle sprain management depends on the severity of the injury, ranging from self-care measures to medical treatment. Most cases respond well to conservative approaches, while severe injuries may require specialised intervention.

Non-Surgical Treatment

RICE protocol: Rest, ice, compression, and elevation help reduce swelling and pain in the first 24–72 hours. Rest involves limiting weight-bearing, ice is applied for 15–20 minutes several times a day, compression supports the ankle with a bandage or sleeve, and elevation keeps the ankle above heart level when possible.
Pain management: Over-the-counter medications such as paracetamol or NSAIDs help relieve pain and inflammation. Some patients may benefit from topical anti-inflammatory gels applied directly to the injured area.
Immobilisation: Braces, splints, or walking boots may be used to restrict movement, typically for 1–3 weeks in moderate to severe sprains.
Physical therapy: Rehabilitation exercises restore strength, flexibility, and balance. Therapy begins with range of motion exercises and gradually progresses to strength training and functional movements to reduce the risk of reinjury.

Surgical Treatment

Ligament repair: For complete ligament tears causing significant joint instability, the torn ligaments may be reattached using sutures or anchors. This procedure restores normal joint function and reduces the risk of recurrent sprains. Recovery typically involves a period of immobilisation followed by structured rehabilitation.
Arthroscopy: A minimally invasive technique where a small camera and specialised instruments are inserted through tiny incisions to assess and treat ligament damage. This procedure may also address associated injuries, such as cartilage damage or loose bone fragments, reducing long-term complications and promoting a smoother recovery.
Ligament reconstruction: In cases of chronic instability where the ligaments are too damaged for direct repair, tendon grafts may be used to reconstruct ligament function. The graft is typically taken from a nearby tendon or a donor source to restore ankle stability and function.

Prevention and Management

Preventing ankle sprains involves strengthening the surrounding muscles, improving balance, and wearing proper footwear. Exercises such as calf raises, resistance band work, and balance training enhance stability. For those with previous injuries, ankle supports offer additional protection during high-risk activities. A proper warm-up prepares the muscles and ligaments, while progressively increasing activity levels strengthens the ankles. Completing rehabilitation after a sprain, even when pain subsides, prevents chronic instability and reduces the risk of reinjury.

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

MBBS (S’pore)
MRCS (Ireland)
MMed Orthopaedic (S’pore)
FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

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Sprained Ankle

Frequently Asked
Questions

How do I know if my ankle sprain is serious?

If you experience severe swelling, bruising, inability to bear weight, or a popping sensation at the time of injury, you may have a severe sprain or fracture. A medical evaluation is recommended.

How long does it take for a sprained ankle to heal?

The healing time for a sprained ankle varies by severity. Mild sprains heal within 1–2 weeks, while moderate sprains take 3–6 weeks due to partial ligament tears. Severe sprains may require 8+ weeks, especially if rehabilitation is needed. Proper care, including rest and therapy, supports full recovery.

Can I return to sports after a sprained ankle?

Athletes should only return to sports once strength, balance, and range of motion are restored. Functional testing and ankle taping may be recommended before resuming activity.

Sprained Ankle

Symptoms of a Sprained Ankle