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.
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:
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:
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:
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:
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.
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.
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:
Imaging such as X-rays, and sometimes MRI or CT scans, are needed for accurate diagnosis.
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.
Nerve or blood vessel injury is uncommon but can occur in more violent or complex ankle traumas.
Symptoms might include:
If any of these symptoms occur, urgent medical assessment is required.
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.
Here are some signs that your ankle injury may require specialist input:
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 depends on the nature and severity of the injury.
Options may include:
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.
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.
Martin Klinke is one of the leading ankle surgeons in London. With an impressive background in both Orthopaedics and Sports Medicine, he takes a comprehensive and compassionate approach to your treatment. He’s a trusted, reputable surgeon who can help get you back in the game!
Mr Martin Klinke offers outpatient consultations at HCA at the Shard, Chiswick Outpatient & Diagnostic Centre, HCA Canary Wharf, BUPA Cromwell Hospital and the New Victoria Hospital. He operates from London Bridge Hospital, BUPA Cromwell, and New Victoria Hospital and the Hospital of St John and St Elizabeth.
You can find all his patient reviews here.
