Ankle Sprains

You rolled it. The outside of the ankle swelled up within the hour, it bruised by the next day, and it hurts to put weight through.

Ankle sprains are the most common musculoskeletal injury there is, and they are also the most casually managed. The reason that matters is the number underneath it: a large proportion of people who sprain an ankle go on to recurrent sprains or ongoing instability, and the strongest predictor of spraining an ankle is having sprained it before.

What is actually damaged

Most sprains are inversion injuries — the foot rolls inward under you and the ligaments on the outside of the ankle are overloaded. The anterior talofibular ligament goes first, and in a more forceful injury the calcaneofibular ligament follows.

Two less common patterns behave differently and are worth naming, because they are the ones that get treated as ordinary sprains and take much longer than expected:

• A high ankle sprain injures the syndesmosis, the ligament complex binding the two shin bones together above the joint. Pain is higher up, squeezing the leg reproduces it, and recovery is considerably longer.
• A medial sprain damages the deltoid ligament on the inside. Less common, more often associated with a fracture.

What has to be ruled out

A sprain and a fracture can feel similar in the first hours, and several injuries hide behind a rolled ankle:

• Fractures of the fibula, the base of the fifth metatarsal, or the talus
• Osteochondral injury — damage to the cartilage surface inside the joint, which typically shows up as an ankle that keeps aching and catching long after the swelling settles
• Peroneal tendon injury
• In children, a growth plate injury rather than a ligament tear, because growth plates are weaker than the ligaments crossing them

Your podiatrist assesses against the Ottawa ankle rules, which are the validated criteria for who needs an X-ray, and refers where they are met.

What the appointment involves

History and mechanism first — which way it rolled, whether you could weight-bear immediately, whether you have done it before.

Then examination: where it is tender, how much swelling, joint stability testing, the range through the ankle and the subtalar joint below it, and calf strength. Once acute pain settles, balance and gait, because those are what determine whether it happens again.

Treatment, and the part everyone skips

Early management is protection, relative rest, and a graded return to loading as symptoms allow — not immobilisation, and not weeks on the couch. Compression and elevation help swelling. Where the injury is significant a period in a CAM boot may be warranted.

The part that decides whether you are back here in a year is the rehabilitation, and it is the part almost everyone stops early.

That means calf and peroneal strengthening, and balance retraining — single-leg work, progressing to unstable surfaces and then to sport-specific movement. Pain resolves well before the joint’s position sense does, so finishing when it stops hurting leaves the mechanism of the next sprain fully intact.

Where the foot’s mechanics contributed — a high-arched foot that sits in a slightly inverted position is more prone to rolling — orthotics and footwear changes are part of the plan rather than an afterthought.

⚠ An ankle that is still swelling, catching, giving way or aching three months on has not simply failed to heal. That picture warrants reassessment for a cartilage injury, a missed fracture, or mechanical instability, rather than more time.