Understanding Ankle Sprains

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What is an Ankle Sprain?

A “sprained ankle” is one of the most common injuries that can occur when the ligaments around the ankles are stretched beyond their normal range.

Ligaments are bundles of connective tissues that connect adjacent bones together. They help to keep our joints stable and prevent excessive movements.

ankle sprain

What Causes Ankle Sprain?

Ankle ligaments are non-elastic, meaning that when they are pulled beyond a certain range, they can be torn or injured. Hence the reason ankles are susceptible to regular injury.


Types of Ankle Sprain

Different mechanisms of injury produce different types of sprains:

ankle ligament anatomy and types of sprains

Lateral Ankle Sprain

In the case where your ankle “rolls over” itself when pivoting or turning, the lateral ankle ligaments (outside) ligaments get injured. We call this a lateral ankle sprain or ankle inversion sprain.

The ligaments involved in this type of sprains are the

a) anterior talofibular ligament (ATFL),

b) posterior talofibular ligament (PTFL), and

c) calcaneofibular ligament (CFL).

Usually not every ligament will be torn, and the ATFL is the most commonly injured ligament, accounting for 73% of lateral ankle sprains.

Medial Ankle Sprain

Medial ankle sprain or eversion ankle sprain happens when sudden movements cause the ankle to roll inwards and overstretch a group of ligaments called the deltoid ligament. Medial (inside) ankle sprains are less commonly occurring, comprising of only 6% of all ankle sprains.

This type of sprain is commonly seen among gymnasts when they miss a landing and land on the insides of their heels, or, an opposing rugby player performing a slide tackle to the opponent’s side, causing the player’s ankle to roll inwards.

cause of medial ankle sprain


High vs Low Ankle Sprain

What is a high ankle sprain

A high ankle sprain (syndesmotic ankle injury) is when the ligaments in the joint that connect the two bones right above the ankle (tibia and fibula) are forcibly stretched and torn.

This can happen during high-impact sports like football or basketball where there is a sudden twisting of the ankle above the foot at high speeds (fast twisting and turning movements).

What is a low ankle sprain

In contrast, low ankle sprains are the sprains that we are most familiar with. As described above, a low ankle sprain depends on which direction your ankle twists – inwards (lateral/inversion sprain) or outwards (medial/eversion sprain).

What is the difference between high and low ankle sprain?

The main difference between high and low ankle sprains is that high ankle sprains do not show much swelling or bruising compared to low ankle sprains, due to the torn ligaments being deeper in the joint.

Low ankle sprains will tend to show swelling and discolouration at the twisted area. A common and easy way to check is by the ‘squeeze test’ (using your hand to squeeze the tibia and fibula at midcalf), which will cause pain in a high ankle sprain.


Severity of Sprained Ankle

Ankle sprains are categorised into different grades, from mild to severe, with milder sprains being easier to rehabilitate.

different grades of ankle sprain


Grade 1 Ankle Sprain

Ligaments are stretched but not torn. Swelling may be mild, and without any feeling of instability (ankle giving way). Function is not affected, so while walking might be uncomfortable and stiff for a week or so, it is still possible.

Grade 2 Ankle Sprain

Ligaments in the ankle are partially torn. Bleeding may occur in the surrounding areas, causing bruising and discolouration. Swelling may also get worse over the period of a week, damaged areas tender to touch, and functions such as walking or climbing stairs will be painful.

Grade 3 Ankle Sprain

The most severe type of sprain, where at least one ligament is completely torn. The ankle will feel unstable or “wobbly”, bearing weight on it will be usually impossible due to severe pain.


Ankle Sprain Recovery Time

The recovery of an ankle sprain depends on the severity of the injury and the treatment plan for recovery. Severity of the injury is divided into three grades (Grade I, II, III).

Grade I ankle sprains are the mildest and will recover within a few days to 2 weeks, normally treated with rest and ice.

Grade II ankle sprains are when the ligaments are not fully torn, and healing time will usually take 2-4 weeks with adequate rehabilitation.

Grade III sprains can take 6-12 weeks as the ligament tearing is more severe, and requires periods of rest and rehabilitation. High ankle sprains also require longer healing time compared to low ankle sprains, anywhere from 6 weeks to 3 months and usually require longer periods of rest and physical therapy than low ankle sprains to gain back normal strength.


Ankle Sprain vs Broken Ankle – How Can You Tell?

It is easy to mistaken ankle fractures for ankle sprains because both conditions would show immediate swelling. Here are a few common symptoms to identify whether you have sprained or fractured your ankle:

Ankle Sprain or Fracture Symptoms
Ankle Sprain Numbing pain
Visible swelling and/or bruising
Restricted range of motion
Tenderness when standing or adding weight to foot
Instability when walking
Broken or Fractured Ankle Immediate sharp pain that does not go away
Visible swelling and bruising
Tenderness when touched
Visibly deformed
Trouble adding any weight to foot


In the case where you can not tell whether your condition requires medical care, we advise to seek professional examination immediately as doctors are able to diagnose your injury through special tests for ankle sprain.

If a fracture is identified, you will need to get an x-ray for further examination.


Ankle Sprain Treatment – How To Treat an Ankle Sprain?

Depending on the severity of your sprain, you could seek professional help with a physiotherapist to help you with your ankle sprain recovery.

Rehabilitation after an ankle sprain focuses on several stages:

  1. Reduction of pain and swelling (e.g. P.OL.I.C.E see here)
  2. Regaining back mobility of the ankle
  3. Strengthening of the surrounding muscles
  4. Stabilisation: Increasing the sensing ability of the ankle to balance itself during activities

The goal is to help you progressively reduce pain and to regain back the mobility, strength, and stability of the injured foot to restore your daily functioning.

If your ankle sprain is mild, here are a few tips you could do to treat your sprained ankle at home.

ankle sprain treatment


Seeking proper rehabilitative care for your ankles after an injury is important to prevent future instability of the ankle which highly increases the chances of a recurring sprain that might take longer to heal.

Here at Spinefit Chiropractic, we care about your goals to return to function and sports. Give us a call or drop us an e-mail to book an appointment today so that we can work together with you to get you back on track!