An ankle sprain is an overstretch or tear of the ankle ligaments, most often on the outer side. Recovery ranges from one to twelve weeks depending on grade. Up to 40 percent have an associated injury, so a sprain that is slow to settle is worth assessing to avoid lasting instability.
Symptoms
- Pain, swelling and bruising after a twist
- Difficulty weight-bearing in more severe injuries
- A feeling of looseness or the ankle giving way
- Grade 2 (partial tear) is the most common and most often undertreated
Causes & risk factors
- The foot rolling inward
- Mostly the lateral ligaments (ATFL then CFL)
- Inner (deltoid) and high ankle (syndesmosis) sprains take longer
- Associated injuries: cartilage lesions, peroneal tendon tears, base-of-fifth-metatarsal fractures
Conservative treatment comes first
- Modern acute care — PEACE & LOVE, not RICE: protection, elevation, avoiding anti-inflammatories in the first 72 hours, compression, education
- Then load, optimism, vascularisation and exercise from day three
- Staged rehab: movement → strength → single-leg balance → sport-specific
- Criteria-based return to sport, guided by function not the calendar
When surgery is considered
Most ankle sprains never need surgery. Persistent instability after 12–16 weeks of good rehab can be treated with a lateral ligament reconstruction (Broström).
Questions & answers
Not always. The Ottawa Ankle Rules guide this: an X-ray is needed if you cannot take four steps, or there is bony tenderness over specific points.
Grade 1, no. Grade 2 to 3, a short period (1 to 2 weeks) only, then progressive movement.
Roughly 1 to 2 weeks for Grade 1, 4 to 6 for Grade 2, and 8 to 12 for Grade 3, guided by function rather than the calendar.
Repeated giving way suggests chronic instability from incomplete rehab, which is treatable.
Sources & further reading
- NHS — sprains and strains
- NICE CKS — sprains and strains
- OrthoInfo (AAOS) — sprained ankle
