Is Your Ankle Sprain More Serious Than You Think? Signs You Should See a Specialist
Most of us have “gone over” on our ankle at some point, whether during a run, playing sport, or simply stepping off a curb awkwardly. Often, it’s dismissed as “just a sprain.” But what many don’t realise is that not all sprains are the same - and some ankle injuries can be much more serious than they first appear.
In my clinical practice, I regularly see patients who delayed assessment and treatment for what they thought was a simple sprain, only to discover they have sustained a more complex injury.
Early assessment and appropriate care can make a big difference - not only in healing time, but also in preventing long-term complications.
So how do you know if your ankle sprain is just a minor injury, or something more? Let’s explore what happens during a sprain, the signs of more serious damage, and when it’s time to see a foot and ankle specialist.
What Exactly Is an Ankle Sprain?
A sprain occurs when the ligaments - tough bands of tissue that connect bones - are stretched or torn. In the ankle, most sprains involve the lateral ligament complex, which includes three key ligaments on the outside of the ankle:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
The ATFL is the most commonly injured ligament in a classic ‘inversion injury,’ when the foot twists inward.
Sprains are typically graded according to severity:
- Grade 1: Mild stretch or microscopic tear, minimal swelling.
- Grade 2: Partial ligament tear, moderate pain and swelling, difficulty bearing weight.
- Grade 3: Complete ligament tear, significant swelling, bruising, and instability.
When Is It More Than Just a Sprain?
While many sprains do heal well with rest and rehab, certain symptoms, or the mechanism of injury, should raise concern for a more serious issue.
Here are some important conditions to be aware of:
Syndesmosis Injury (High Ankle Sprain)
Unlike common ankle sprains that affect the outer ligaments, a syndesmosis injury involves the ligaments connecting the tibia and fibula - the two long bones of the lower leg. These are higher up the ankle and are crucial for stability.
Red flags for syndesmosis injury:
- Pain above the ankle joint
- Pain with squeezing the calf or twisting the foot outward (external rotation)
- Difficulty walking despite minimal bruising
High ankle sprains take significantly longer to heal and, if left untreated, can lead to chronic pain and dysfunction. These injuries are especially common in sports like rugby or skiing.
Avulsion Fracture
Sometimes, rather than the ligament tearing in isolation, a small piece of bone is pulled off where the ligament attaches - this is called an avulsion fracture.
This can mimic a severe sprain but often requires different treatment. X-rays or advanced imaging may be needed to confirm the diagnosis.
Other Foot or Ankle Fractures
It’s surprisingly common for fractures to be mistaken for sprains, especially in the fifth metatarsal, talus, or fibula.
Signs a fracture may be present:
- Inability to bear weight immediately after the injury
- Localised bony tenderness
- Significant swelling or bruising not improving after a few days
Imaging such as X-rays, and sometimes MRI or CT scans, are needed for accurate diagnosis.
Osteochondral Defect
An osteochondral defect refers to damage to the cartilage and underlying bone within the joint - typically in the talus bone.
These injuries can occur at the time of a sprain and may not be immediately obvious. Over time, they can cause persistent deep ankle pain, swelling, or a sensation of catching or locking.
Neurovascular Injury
Nerve or blood vessel injury is uncommon but can occur in more violent or complex ankle traumas.
Symptoms might include:
- Numbness or tingling
- Weakness in the foot or toes
- Cold, pale skin
If any of these symptoms occur, urgent medical assessment is required.
Chronic Ankle Instability
Sometimes the problem isn’t the initial injury, but what happens afterward. Ligaments that don’t heal properly can result in chronic instability, where the ankle frequently “gives way.”
This can interfere with daily activities or sport, and often leads to recurrent sprains and long-term joint degeneration if left untreated.
What Symptoms Should You Look Out For?
Here are some signs that your ankle injury may require specialist input:
- Severe or persistent pain beyond 5–7 days
- Significant swelling or bruising, particularly if it doesn’t improve within a week
- Inability to walk or bear weight for more than 48–72 hours after injury
- Recurrent episodes of your ankle “giving way”
- A sense of deep joint pain or clicking
- Numbness, tingling, or coldness in the foot
- Pain above the ankle joint (possible high ankle sprain)
What’s Normal Recovery, and When Should You Seek Help?
For a mild Grade 1 sprain, recovery typically takes 1-2 weeks with rest, ice, compression, and elevation (RICE), followed by early rehab.
Grade 2 injuries may take 4-6 weeks, while Grade 3 or more complex injuries can take 3 months or more, especially if surgery is required.
If you’re still limping or unable to return to sport after 4–6 weeks, it’s time to see a specialist!
Treatment Options
Treatment depends on the nature and severity of the injury.
Options may include:
- Physiotherapy: Key for restoring range of motion, strength, and balance.
- Gait Analysis: To ensure your walking or running technique is optimal and address any issues.
- Bracing or boot immobilisation: For moderate to severe sprains or fractures.
- Shockwave therapy or injections: In chronic cases or osteochondral injuries.
- Surgery: For severe ligament tears, fractures, syndesmosis injuries, or cartilage damage.
As a foot and ankle surgeon, my role is not always to operate, but to ensure you receive the right diagnosis and pathway - whether that’s conservative management or surgical intervention.
I work with a great team of healthcare professionals such as Physiotherapists and Podiatrists to ensure that my patients receive the best possible, multidisciplinary care, whether surgery is required or not.
Final Thoughts
Ankle injuries can be deceptively complex. While many do recover with time and rest, it’s important to listen to your body, and to seek help if things don’t feel right.
A missed diagnosis can delay healing and impact your long-term function.
If you’ve recently injured your ankle and have any of the symptoms mentioned above, don’t hesitate to get in touch. Early intervention often makes all the difference.