When is it not a Simple Ankle Sprain?

man with his injured sprained ankle


What is an Ankle Sprain?

An ankle sprain is a common injury that usually occurs when your ankle ligaments are stretched beyond their limit and are either partially or fully torn. Ankle sprains can occur in people of any age. These types of injuries usually range from mild to severe depending upon the damage caused to the ligaments.

Most ankle sprains are minor and they can be easily treated at home using different remedies like applying ice or having appropriate rest. However, if your ankle becomes progressively more painful or is badly swollen, then its perhaps best for you to consult your doctor immediately because a persistently swollen ankle will cause a lot of difficulty walking and putting weight on your ankles.

Unfortunately, most of us don’t pay appropriate attention to our ankle sprains. If they are not treated properly and worse still ignored without rehabilitation, then the ankle weakens, making it prone to other sorts of injuries. Don’t confuse a sprain with a complete tear. A sprain typically implies the soft tissues have been elongated or inflamed, whilst a rupture implies there is a discontinuity in the structure of the tendon/ligament/muscle.

You may have an ankle sprain when you accidentally twist, move, or rotate your ankle in an abnormal way. This may lead to tears or over-stretching of the ligaments which hold your ankle bones and joints together.

What happens in an ankle sprain?

Ligaments are fibrous and strong ‘connective tissues’ that are responsible for connecting your bones to other bones. The ligaments present in your ankle are responsible for keeping your bone in a proper position and therefore stabilizing the joint.

Ankle sprains typically affect the lateral ligaments present on the outer side of your ankle. Sprains can be of different severity as they range from tiny tears in fibers to complete tears in your ligament tissues. If your ligament has a tear, this can render your ankle unstable and with the passage of time, other joint segments your ankle and foot complex may get affected.


What Are the Causes of Ankle Sprains?

Some most common causes of ankle sprains are:

  • Landing awkwardly on your foot after jumping – this action may injure your ligaments.
  • When you wear shoes which lacks adequate heel support resulting in a twisting injury
  • Running on uneven grounds, for example, on stoned pebble pavements or pathways.
  • When you step your foot into a hole unknowingly and twist your foot in the process
  • During exercise, you may overdo some actions and tear your ligaments.
  • When doing sporting activities like Soccer, Basketball, or Volleyball, players often stop and start or make sudden cutting movements that could result in a sprain.


What Are the Symptoms of Ankle Sprains?

The most common symptom of an ankle sprain includes severe pain in the ankle. It can be accompanied by several other symptoms like:

  • Swelling in your ankle
  • Bruising
  • Tenderness to touch
  • Instability or ‘apprehension’. This usually occurs when if you have a complete ligament tear or dislocation of the ankle joint.

If your ligament is torn severely, then you might also hear of feel a pop in your ankle. The symptoms of the severely torn ankle are very similar to that of broken bones, so it is recommended to see a doctor sooner rather than later.


When is it not a Simple Ankle Sprain?

Most people don’t take ankle sprains very seriously. Whilst it is true that with most ankle sprains, ligaments take the brunt of it, in high energy sprains, the ankle cartilage might also get damaged. This leads to cartilage defects in the ankle, commonly referred to as osteochondral lesions. This condition is a precursor to ankle arthritis and, if left untreated, can quickly progress with pain, swelling, and eventual deformity.

An ankle sprain that is still problematic after six weeks should warrant a specialist consultation with a view to performing X-rays and maybe an MRI scan. This is the best way to diagnose cartilage or other associated damage to the ankle from the sprain.


Physical Examination

Your doctor will carefully examine your foot and ankle to diagnose your ankle sprain. Sometimes the physical examination might be uncomfortable for patients.


Your doctor will gently press around your ankle to determine which ligament is damaged.

Range of motion

Your doctor will try to move your ankle in different directions. If your ankle is swollen, then it will not move much.


If the ankle sprain hasn’t affected your bone or internal structures significantly, then your doctor might be able to determine the severity of your ankle sprain based on the methods discussed above.


What else can be damaged aside from the Ligament In Ankle Sprains?

As discussed earlier, ankle sprains usually damage your ligaments, but a question that might come to your mind is ; How else can an ankle sprain affect you? Besides ligaments, ankle sprains could also affect the following:

  • Tendons

Other than your ligaments, the most common thing that is damaged due to ankle sprains are your tendons. If your tendons are injured, one may experience ongoing pain with movement or clicking, usually on the outer side of your ankles, even after the swelling is gone. The pain usually occurs when you try to perform an activity. If it is left untreated, then your pain may recur, along-with swelling.

  • Cartilage

Sometimes the ankle sprains can also damage your ankle cartilage. Cartilage damage is difficult to detect because it is usually not apparent on plain X-rays. One would need to do an MRI scan to detect cartilage damage. This is also a common reason behind persistent pain in your ankles.

  • Bones

Severe ankle sprains could cause a fibula fracture. In this setting, if the bone is displaced or unstable, surgery may be needed to re-align the fracture and stabilize it with a small plate or screws.


What Are the Different Types of Ankle Sprains?

Based on the anatomy of your ligaments, ankle sprains are classified into different categories.

Lateral Ankle Sprain

This is the most common type of ankle sprain (about 70-85%) that may affect people in their everyday activities, including sports and exercise. It happens when the ankle is excessively inverted and the lateral ligaments are over-stretched, thus affecting the lateral part of the ankle ligament complex. This type of ankle sprain typically damages the anterior talofibular ligament and calcaneofibular ligaments.

Medial ankle sprain

Unlike the lateral ankle sprain, this type of sprain is relatively infrequent. It is typically caused by an eversion injury, and it affects the medial part (inner part) of the foot. It happens when the deltoid ligaments tear on the inside of the ankle. Sometimes, the fibula bone could be fractured when this happens.


Different Grades of Ankle Sprains

To determine the grade of ankle sprains, you should visit your doctor because he will help you to determine the grade of your ankle sprain based on the damage caused to the ligament. He will also assist you in developing a treatment plan for a swift and more tactical recovery.

Grade 1

The grade 1 ankle sprain happens when a ligament(s) experiences slight damage. The affected joint does not experience any complication as it is in a stable condition.

Grade 2

The grade 2 ankle sprain happens as a result of a partial tear to a ligament. The ligament here is overstretched to the degree that it becomes loose.

Grade 3

The grade 3 ankle sprain happens as a result of the complete tear of a ligament, which in turn affects the stability of the affected joint. You will see signs of bruises around the ankle if the severity reaches this grade.

High ankle sprain

This kind of sprain is the one that happens to large ligaments that are located above the ankle that connects the two long bones of the lower leg, that is, the fibula and tibia. A high ankle sprain happens when the foot is right on the ground, and an excessive outwards twisting force is applied to the foot. This type of ankle sprain is commoner in sports like football, basketball, horse riding and volleyball.


Imaging Tests


X-rays are used to get images of dense structures in your body, like your bones. Your doctor may ask you to undergo a standing ankle x-ray to determine if there is a broken bone in your ankle because the symptoms are quite similar to severe ankle sprains.


If your doctor suspects a severe soft tissue injury, then he or she may recommend you have an MRI scan. The MRI is typically only ordered once the swelling and bruising around your ankle has settled.


By using an ultrasound scan, your doctor can view your ligament directly. The advantage of an ultrasound scan is that one can stress the ligament whilst scanning it. On the reverse, the ultrasound is not as sensitive as an MRI scan.


Treatment Options Available for Ankle Sprains

Home Treatments

For home treatment. You can use RICE – this acronym simply means rest, ice, compression, and elevation. This can subside the swelling and pain some days after the injury. You can also use Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or Arcoxia to control the pain and swelling. These treatments are usually better for mild sprains.

Non-Surgical Treatments

Some sprains require additional treatment other than RICE protocol and medication.


You can use crutches if the pain is too much to bear. With the crutches, you will be able to offload your ankle.


This helps with maintaining joint motion, strength and finally to improve ankle stability.


In the early phase of treatment, it is crucial to protect your ankle from sudden movements. You can use a removable plastic device such as a cast-boot or air stirrup-type brace for a grade 2 ankle sprain. It will provide appropriate support to your ankle. For a grade three sprain, you can use a short leg cast or a walker boot for 2 to 3 weeks.


Surgical Treatment

Surgical treatment for ankle sprains is very rare. There are very few cases that require to perform surgery. Surgery is only needed when all non-surgical treatments fail to respond to the injury. For ankle sprains, you have the following surgical options:


In arthroscopy, your doctor uses a small camera to take a look inside your ankle joint. They use miniature instruments to remove any loose fragments of bones or cartilage. In the same setting, the ligaments are reconstructed using suture material to restore the continuity. Patients are usually fully weight bearing post procedure in a walker boot.


In cases where the ligament is severely damaged, the surgeon may have to replace the damaged ligament with a graft obtained from other ligaments or tendons found in your foot. This is called a graft reconstruction and is usually done through an open incision.

Based on the severity of your injury, your doctor will decide which treatment option is best suited for you. If you have any questions regarding ankle sprains or if you need to know more about the treatment options, then please contact Dr. Gowreeson Thevendran


Dr Gowreeson Thevendran
Dr Gowreeson Thevendran
Consultant Orthopaedic & Trauma Surgeon
Island Orthopaedics (Mount Alvernia Hospital & Mount Elizabeth Novena)

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Dr Gowreeson Thevendran is a Consultant Orthopaedic & Trauma Surgeon with a sub-specialty interest in the lower limb – foot and ankle, knees and hip conditions.
He is a UK-trained orthopaedic surgeon with dual-fellowship accreditation from Vancouver, Canada (foot & ankle), London, United Kingdom (sports surgery) and Liverpool, United Kingdom ( complex trauma). He is also extensively published and continues to collaborate for clinical research whilst lecturing in regional and international postgraduate meetings.