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What is an Ankle Sprain?

Ankle injuries tend to result from when your foot turns in on itself. This injury stretches and weakens the ligaments that bridge the ankle and foot bones. Ankle injuries are the most common athletic injuries. The condition is usually defined according to the extent of the damage suffered by the ligament.

A normal ankle joint consists of three bones connected by rubber band-like ligaments. The bones meeting at the ankle joint are called the tibia, fibula and talus. A normal ankle gives us the ability for motion because of power provided by the muscles and tendons surrounding the ankle ligaments. When these ligaments are torn or ruptured, the ankle is "sprained."

Ankle sprains are one of the most common types of injuries because of the pressure the ankle is subjected to constantly. The average ankle joint is placed under as much of 63 tons of pressure per each mile walked.

The ankle is important not only because it supports our weight, but also because it acts as a lever that helps move the body forward. The ankle joint primarily operates by swinging the foot up and down; it also swivels the foot from side-to-side. The ankle and the subtalar joint position the foot to carry the foot on uneven and slanted surfaces and does this almost instantly when running in the woods for instance.

Ankle sprains are common ankle injuries. They occur when a ligament connecting bones or cartilage of the ankle is strained (overly stretched), ruptured, or torn.

This type of injury can be classified by the extent of damage to the ligament. First-degree sprains are the most common and the mildest. In first-degree sprains, ligaments are overly stretched but not torn, and pain and swelling are minimal. The injured person can put weight on the ankle.

In moderate, second-degree sprains, the ligament is partially torn, and pain and swelling are greater due to bleeding from torn tissue.

Third degree sprains are the most serious, and can even (rarely) require surgery. A third-degree sprain requires a long period of rehabilitation to heal fully. A third-degree sprain may be accompanied by a popping sound and your ankle may look strangely twisted. Swelling is usually severe; the skin may be discolored. Weight cannot be put on the injured ankle.

If you suspect a second- or third-degree sprain, you should see your physician immediately.

Three Types of Ankle Sprains

There are three major classifications of ankle sprains. The most common and mildest type is a first-degree sprain in which the ligaments are stretched with minimal pain and swelling. In cases of a first-degree sprain the ankle ligaments are stretched without ripping the collagen fibers which make up the essence of the ankle. Second-degree sprains involve the actual tearing of the ligaments and fibers without total rupture. There tends to be more bleeding involved in these sprains because of the damage done to the torn tissue. Third-degree sprains require a complete rupturing of the ligaments and can involve surgery. These sprains tend to require a long period of rehabilitation. Third-degree sprains can include symptoms such as an ankle that "pops" in and out. Also, in especially severe cases, the ankle can look twisted and deformed. These third-degree sprains tend to require no weight be put on the ankle; discoloration can also occur. With these sprains, the ankle may need to be put in a cast for as long as several months, but surgery is rarely necessary. When surgery is called for doctors usually want to repair a tendon—or reconstruct an ankle ligament.

Causes of an Ankle Sprain

They usually result from the foot turning inward, stretching or tearing the ligaments on the outside of the ankle. They can occur from jogging, dancing, playing sports, or from inadvertently stepping into a pothole in your street or a depression in your lawn.

Contributing factors may include:

  • Failure to warm up calf muscles properly before and after exercise
  • Poor or worn-out shoes or shoes that fit improperly
  • Previous ankle injury
  • Uneven surfaces
  • Obesity

Symptoms of an Ankle Sprain

There are a variety of clear symptoms for ankle sprains, but many of the warning signs vary depending upon the severity of the sprain. These symptoms include extreme pain; the inability to put weight on the foot; bruising; swelling; and general instability. Doctors often use X-rays of the ankle and foot to determine where fractures and dislocations are located. With severe ankle sprains, doctors will occasionally use computerized tomography (CT) and magnetic resonance imaging (MRI) to get a detailed look at the soft tissues surrounding the ankle joint. The MRI is a radiographic test that uses magnetic waves to illustrate the ankle. MRIs reveal the ankle's tendons and tissues and are thus very helpful to doctors trying to make a diagnosis in more severe cases.

Doctors also use simple tools like the drawer and tilt tests to make a diagnosis. With the drawer test, your doctor will be able to assess the instability of your ankle by stabilizing the leg and subsequently moving the heel back and forth. In the tilt test, doctors turn the heel from side to side to gauge opening up of the ankle mortise inside and outside.

Treatments of an Ankle Sprain

Conservative treatments include basics like rest, ice, compression of the ankle, and elevation of the ankle. Doctors use elastic bandages, splints, short leg casts, or braces to compress sprains and to keep the joint from moving. Once the leg is stabilized, elevation should take place. When elevating the leg with the sprained ankle, it is important to keep it above the level of your hips whenever possible. For the first two or three days after the injury, use ice on the sprain as often as possible. Also remember bracing and taping the ankle can make dramatic contributions to the recovery process.

Non-steroidal anti-inflammatory drugs and muscle relaxants can also be extremely helpful during the recovery period. If you do get prescribed some medication, be certain to take it as scheduled. While these medicines can cause nausea or drowsiness, they also help millions get through the pain that follows the sprain.

In the most severe cases, doctors may recommend crutches to avoid putting weight on the injured ankle. Most ankle sprains heal within a relatively short time period of three to eight weeks. In more severe cases, healing may take longer. And while surgery is quite rare, casts are not. The norm for patients with severe sprains can be up to three weeks in a walking cast. These casts are usually made of fiberglass and can be removable or non-removable.

If there is no improvement after several days or if swelling and pain are severe, consult a physician. For third degree sprains, the ankle may need to be placed in a cast for several months, followed by a long period of rehabilitation. Surgery is rarely required.

Exercises for Ankle Sprains

Ankle sprains can be complicated by many factors. In some cases, the nerve supply to injured ligaments can be damaged. These nerves are critical to ankle function because they are proprioceptors that give the ankle its sense of position. It is crucial to retrain the injured ankle to replenish these neural connections-they are a must-have for stability. Fortunately, several easy and at-home exercises we will review below can help.

Strengthening exercises can usually be started in the few days after the injury is sustained. One such exercise is called a "stork stance" and it requires that you alternately stand on each single leg with your eyes closed for one minute. This exercise creates muscle training for the muscles that stabilize the foot.

Ankle injuries usually occur because the ankle has "rolled" inward. Therefore, any motion that mimics movement in either the same or opposite direction as the injury should be avoided. Straight pointing and flexing of the foot is recommended 7-10 times a day. But don't hurt yourself! Everyone's injury differs, as does everyone's rehabilitative calendar.

Other muscles that should be exercised include the gastrocnemius and soleus calf muscles. These muscles can be exercised by placing your uninjured foot under the ball of the injured foot. By gently applying tension as you push the foot away from the body, you will strengthen these key muscles.

Another essential muscle to ankle function is the anterior tibialis. By placing the uninjured foot on top of the sprained ankle, slowly flexing the sprained ankle toward the knees, and holding the ankle at the knees before releasing, you will fortify this primary muscle. The above exercises should be performed as three sets of 10-20 repetitions. The lateral peroneal muscles when tested after the ankle is non painful are almost always weaker than the opposite side. Peroneal muscle exercises are easy to do while sitting with the heels between chair legs and pushing laterally with the foot to roll the foot outward.

One other useful exercise is the two-legged knee dip. Begin this exercise with your weight spread equally between your shoulders while standing in a partially bent knee stance. Slowly bend each knee to an angle of approximately 90 degrees. If you find after a few days that the exercise has left you feeling strong, you may want to try a single-stance knee dip. This exercise should be performed in 2–3-minute sets with 2 or 3 repetitions of each set.

Toe curls are also useful exercises. They should be performed 5-10 times a day, in or outside of your splint, sitting down with your feet on the ground. Lift your toes and the front of your foot toward the ceiling. Use your opposite foot for resistance as you keep your heel on the ground but rotate the front of your foot inward. Next, find a table leg or some other similar object to turn your foot against while keeping your heel anchored to the ground.

A more idiosyncratic but equally therapeutic and easy to perform exercise requires a tennis ball. Roll the ball underneath your foot for five minutes. Use it to massage your recovering foot.

Also try sitting in a chair with your knee bent about 90 degrees. Pick up pencils or marbles with your toes. Resume the same position on a slick surface and curl a towel under your foot 5-10 times. Repeat the exercise while gradually moving your knee's angle back down toward 0 degrees.

All of the above exercises should be done with an ankle brace because of the control and support it gives the ankle. You want to be careful not to allow the ankle to "roll" again and the brace will go far toward achieving that goal. Within about 2-3 weeks, depending on the severity of the sprain, skiing may be possible. Within 4-6 weeks, your doctor may declare you ready for light jogging, stationary biking and running in place. Using the stair and rowing machines with your splint on is fine. But remember to exercise caution with your fragile ankle.

It is also important to remember the importance of preventive measures. Athletics and other risky activities should always be performed with an ankle brace or tape. Basketball, tennis, and the countless other activities that involve jarring, stopping and starting, and twisting motions cause a great proportion of ankle injuries. Finally, watch for potholes and craggy playing fields-it's so easy to sprain again and again!

A series of stretching, strengthening, positioning, and movement exercises for the ankle can be found at

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

©2000, LLC, Indianapolis, IN

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