Ankle Sprains

Sprained your ankle, keep rolling your ankle or is your ankle in constant pain? Our podiatrist can help you rebuild and strengthen your ankle

Ankle Sprains

Sprained your ankle, keep rolling your ankle or is your ankle in constant pain? Our podiatrist can help you rebuild and strengthen your ankle

What is a Lateral Ankle Sprain?

A lateral ankle sprain occurs when the foot rolls in under the ankle and places excessive strain through the ligaments supporting the outside of the ankle resulting in damage. There are three main ligaments that help to support the lateral aspect of the ankle:

  1. Anterior talofibular ligament (AFTL)
  2. Calcofibular ligament (CFL)
  3. Posterior talofibular ligament (PTFL)

The most common ligament to be sprained in a lateral ankle sprain is the ATFL. However, as the severity of the ankle sprain increases, so does the grading and the number of ligaments involved.

The grading of an ankle sprain is determined by the damage done to the specific ligament involved. Starting from a slight stretching moving through to a complete tear, there are three grades.

Grade One: a grade one ligament sprain occurs when there is a slight stretch resulting in minor damage to the fibers of the ligament. Usually felt like a small pinch, a grade one sprain results in pain and stiffness through the ankle with minor ankle instability.

Grade Two: a grade two ligament sprain occurs when the pressure in the ligament increases to the point in which it results in a partial tear. Similar to a grade one sprain there may be a small pinch, pain, and stiffness, however, grade two sprains differ as they result in increased ankle instability and bruising.

Grade Three: a grade three ligament sprain occurs when there is a complete tear through the ligament. Grade three sprains can be severely painful or completely pain-free due to the associated nerve damage. With a grade three ligament sprain, there is significant ankle instability, bruising, and ankle stiffness.

How is a Lateral Ankle Sprain diagnosed?

Lateral ankle sprains are diagnosed by taking a patient history and performing a physical examination to determine how the injury occurred and what structures may be involved. During the physical examination several pain and movement related of tests are performed to determine exactly what kind of damage has been done and how serious the injury is.

Following severe lateral ankle sprains there is a specific combination of tests performed known as “The Ottawa Ankle Rules”. The Ottawa Ankle Rules are relied upon the determine whether a fracture is present and further investigation such as imaging may be warranted.

How do you treat a Lateral Ankle Sprain?

To treat a lateral ankle sprain, it is important to maintain range of motion, control swelling, and improve ankle strength and stability.

Immediately following an ankle sprain, besides reducing pain, the number one most important thing to do is maintain range of motion through the ankle. All grades of ankle sprains result in ankle stiffness and if not addressed, can work to impede recovery. Secondly, it is important to control the swelling and protect the ankle. Ice, elevation, and tape are often used to reduce swelling and pain. Taping however, should be reserved for experienced sports physicians and health professionals to ensure range of motion is maintained whilst still protecting the ankle.

Once pain has reduced to the point where walking is possible it is important to see a health professional such as a podiatrist or physiotherapist to start the appropriate ankle rehabilitation. Ankle rehabilitation is aimed at improving both strength and stability, and proprioception of the ankle. Without the appropriate rehabilitation the ankle is at higher risk of future lateral ankle sprains and can eventually lead to chronic ankle instability.

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Simply, without the appropriate rehabilitation lateral ankle sprains lead to more lateral ankle sprains which lead to chronic ankle instability. Chronic ankle instability has shown to lead to:

  • A reduction in physical activity; repetitive lateral ankle sprains have shown to reduce physical activity due to a reduction in confidence in the ankle and a reluctance to continue activity due to the risk of re-injury.

  • Negative impacts on physical, mental and social health; due to the lack of confidence and reluctance to partake in solo and social activities has shown to result in an increase in weight gain, stress and a reduction in social inclusion.

  • Increased trauma and risk of osteoarthritis; repetitive trauma can result in damage to the articulating surfaces of the bones in the ankle leading to osteoarthritis.

  • Surgery: Historically, grade three sprain were referred for surgical re-attachment. However recent studies have shown that surgery is not required if the appropriate rehabilitation has been performed. Surgery these days focusses around “cleaning out” the joint spaces of scared tissue and arthritic changes.

Lateral ankle sprain healing rates vary depending on the severity of the injury but can range from 5 days to twelve weeks. Healing rates are commonly as follows:

              Grade One: 5-14 days

              Grade Two: 4-6 weeks

              Grade Three: 8-12 weeks

It is important to keep in mind that following these healing times, once the pain has gone, the ankle is not back to normal. Following a lateral ankle sprain the ligaments have undergone damage and need the appropriate rehabilitation to prevent future injury and further damage.

Expert opinion indicates that pain severity, ankle impairments, sensorimotor control, athlete perception and readiness, and sport specific functional performance should be assessed to inform the return to sport decision following an acute lateral ankle sprain injury.

If you have suffered a lateral ankle sprain and would like to be guided to return to sport safely and reduce your risk of further lateral ankle sprains, click below to book a biomechanical assessment with one of our experienced podiatrists.

The number one cause of an ankle sprain is a previously sprained ankle. Ligaments have nerves in them that play a large roll in telling your brain about the positioning of the body. This is referred to as proprioception. As the ligaments in the ankle are damaged, so are the nerves that provide proprioception. Therefore, after spraining the ankle, the ankle has a reduced ability to signal to the brain where it is, increasing the risk of rolling it again.

Usually as the ankle starts to tilt, the nerves in the ligaments signal to the brain that it is coming close to a critical tipping angle. In response, the surrounding muscle activate to strengthen and support the ankle. Following lateral ankle sprains, when the nerves are damaged, they do not smoothly signal to the brain where the ankle is and when it is coming close to rolling. So, by the time the brain recognises it needs to support the ankle it is to late and it rolls again, causing even further damage.