An ankle sprain is one of the most common musculoskeletal ankle injuries. It occures when the ligaments that support the ankle are overstretched or torn, usually due to a sudden twist, roll, or impact.
The lateral ligaments (on the outside of the ankle) are most frequently affected, particularly the anterior talofibular ligament (ATFL), as these are vulnerable during movements where the foot turns inward (inversion). Ankle sprains can occur during sports, daily activities like walking on uneven ground, or slipping on wet surfaces, and can range from mild to severe depending on the extent of ligament damage.
Ankle sprains are typically classified into three grades.
Grade I is a mild sprain involving microscopic tearing of ligament fibres with minimal swelling and no joint instability.
Grade II indicates a partial tear with more significant swelling, bruising, and some difficulty bearing weight.
Grade III is a complete ligament rupture, often associated with marked swelling, pain, joint instability, and a longer recovery time.
Immediate symptoms usually include pain, swelling, bruising, and difficulty walking or standing on the affected foot. In more severe cases, patients may hear or feel a "pop" at the time of injury.
Proper diagnosis is the key to effective treatment. While most sprains can be diagnosed clinically, imaging such as X-rays may be required to rule out a fracture, especially if there is severe pain or inability to bear weight. In chronic or recurrent cases, an MRI or ultrasound can help assess the extent of ligament damage or associated injuries such as tendon involvement or cartilage lesions.
Although many people assume ankle sprains are minor, untreated or poorly managed sprains can lead to chronic ankle instability, recurrent injuries, and long-term joint problems. Early and appropriate intervention is essential not only for healing but also for reducing the risk of future sprains and improving long-term ankle health.
Treatment for ankle sprains depends on the severity of the injury but always begins with immediate first aid using the POLICE protocol - Protection, Optimal Loading, Ice, Compression, and Elevation - to manage swelling and reduce pain.
In the first 48–72 hours, avoiding excessive weight-bearing and applying ice at regular intervals can significantly ease discomfort. For Grade I and II sprains, conservative treatment is typically effective and includes a short period of immobilisation, followed by a structured physiotherapy programme focusing on restoring range of motion, strength, balance, and proprioception.
Rehabilitation plays a critical role in full recovery and in preventing recurrence. Physiotherapy exercises, such as balance training, resistance band work, and ankle mobility drills, help to recondition the injured ligaments and restore neuromuscular control. Functional rehabilitation also prepares individuals to safely return to sport or everyday activities. Bracing or supportive footwear may be recommended during this transition phase, particularly for athletes or individuals with previous injuries.
In cases of Grade III sprains, or when conservative treatment fails, further investigation may be required. Chronic ankle instability, marked by repeated sprains or a persistent sense of the ankle "giving way", may require more advanced interventions. These include diagnostic imaging to assess ligament integrity and, in some cases, minimally invasive surgery to repair or reconstruct torn ligaments. Modern surgical techniques, such as arthroscopic ligament repair are highly effective in restoring joint stability and function, with excellent outcomes when combined with post-operative rehabilitation.
