Ankle Sprain
An ankle sprain is an injury to the ligaments that hold the ankle together, usually caused by the foot rolling inwards. It is one of the most common injuries there is, and the large majority settle well without surgery.
What matters is recognising the sprains that are not straightforward — those hiding a fracture, and those that fail to settle and go on to cause ongoing ankle instability.
What happens in a sprain?
The ligaments on the outer side of the ankle are the ones usually injured. They can be stretched, partially torn or completely torn. Sprains are commonly graded:
Grade 1: Ligament stretched. Mild swelling and tenderness, walking usually possible.
Grade 2: Partial tear. More swelling and bruising, walking uncomfortable.
Grade 3: Complete tear. Marked swelling and bruising, walking often very difficult.
When should a sprain be assessed?
Most mild sprains can be managed at home. Seek assessment if:
You cannot put weight through the ankle or take more than a few steps
There is tenderness directly over the bone rather than the soft tissue beside it
The ankle looks deformed
There is significant bruising, or numbness in the foot
Pain and swelling are not improving after a week or two
The ankle continues to give way after the initial injury has settled
If this is not your first sprain in that ankle
The first three in particular raise the possibility of a fracture rather than a simple sprain, and an X-ray is the only reliable way to tell.
Early treatment
For most mild sprains, early management is straightforward: relative rest, ice and elevation to control swelling, compression, and gentle movement rather than prolonged rest.
For more significant ligament injuries, Dr Janan often recommends a period of around six weeks in a CAM boot or a rigid ankle brace to protect the healing ligaments. The aim is to allow the ligaments to heal at the correct length, which reduces the risk of ongoing instability later.
In both cases, progressive strengthening and balance work is the part that matters most and the part most often skipped. A sprain disrupts the ankle's position sense, and restoring that is what reduces the chance of spraining it again.
When does a sprain need more than that?
A minority of sprains do not settle. If the ankle remains painful or continues to give way beyond around three months despite proper rehabilitation, further assessment is worthwhile. Possible reasons include:
Chronic ligament laxity, causing ongoing instability
An osteochondral injury — damage to the cartilage surface of the joint at the time of the sprain
A missed fracture
Impingement from scar tissue within the joint
Dr Janan's approach
Dr Janan Chandrananth completed fellowship training in Bristol and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot, with a particular focus on the ankle stability.
Most ankle sprains do not need a surgeon. Where a sprain has not settled, assessment is aimed at finding out why — and non-surgical treatment remains the first approach for most people even then.
Ankle sprain not settling?
Book a consultation with Dr Janan Chandrananth to find out why your ankle is still painful or giving way.
FAQs
How long does an ankle sprain take to heal?
A mild sprain often settles within two to three weeks. A more significant sprain can take six to twelve weeks to feel normal, and some swelling may persist beyond that. Returning to sport before strength and balance have recovered is the main reason people sprain the same ankle again.
Do I need an X-ray?
Not always. X-rays are generally recommended if you cannot bear weight, if there is tenderness directly over the bone, or if there is obvious deformity. Where those features are absent, a fracture is unlikely.
Should I rest it or move it?
Both, in the right order. Rest, ice and elevation help in the first few days while swelling is at its worst. After that, the aim is protected movement rather than complete rest — even where a boot or brace is used, you are generally walking in it rather than staying off the foot. What causes problems is prolonged rigid immobilisation with no movement at all, which leaves the ankle stiff and weak. Once the ligaments have healed, progressive strengthening and balance work is what restores normal function.
Why does my ankle keep giving way?
Usually because the ligaments have healed loose, the balance and position sense have not been retrained, or both. Many people improve with a structured rehabilitation programme. Where instability persists despite that, surgical reconstruction of the ligaments is an option.
Can a sprain cause arthritis later?
A single straightforward sprain generally does not. Repeated sprains and untreated instability can, over years, contribute to arthritis developing in the ankle. This is one reason ongoing instability is worth addressing rather than living with.
Related reading: What Causes Ankle Instability, and When Does It Need Surgery?