Sprained ankle
A common ligament injury of the ankle joint.
A sprained ankle—also called a twisted, rolled, or turned ankle—happens when one or more of the ankle’s ligaments are sprained. It’s the most common sports injury, especially in ball sports like basketball, volleyball, and football, and in racquet sports such as tennis, badminton, and pickleball. It’s also one of the most frequent acute injuries in dance, typically causing ankle pain and, in worse cases, swelling and bruising.
**Signs and symptoms** Recognizing the symptoms helps tell a sprain from a broken bone. A sprain causes a hematoma in the tissue around the joint, leading to a bruise. White blood cells that fight inflammation move to the area, and blood flow increases, bringing swelling and pain. Nerves become more sensitive, so pain feels throbbing and worsens with pressure. Warmth and redness appear due to extra blood flow, and the joint’s range of motion decreases.
**Cause** Ankle sprains are mainly caused by movements like turning and rolling the foot. The risk is highest during activities with explosive side-to-side motion, such as tennis, skateboarding, or basketball. They can also happen in daily life, like stepping off a curb or slipping on ice. Returning to activity before ligaments fully heal can leave them stretched, reducing ankle stability and possibly leading to Chronic Ankle Instability (CAI), which raises the risk of future sprains. Factors that increase risk include: weak muscles or tendons crossing the ankle, especially the peroneal (fibular) muscles on the outer lower leg; weak or loose ligaments (hereditary or from repeated sprains); poor joint proprioception (sense of position); slow neuromuscular response to imbalance; running or stepping on uneven surfaces; shoes lacking heel support; and wearing high heels, which put the ankle in a weak position with a small base of support. Sprains happen when excessive stress—from too much external rotation, inversion, or eversion of the foot—strains the ligaments past their yield point, damaging them.
**Diagnosis** Diagnosis relies on medical history and symptoms, plus distinguishing the sprain from strains or fractures. The Ottawa ankle rule is a simple, widely used tool to tell if an ankle or mid-foot fracture is likely, avoiding unnecessary X-rays. It’s nearly 100% sensitive, so a negative result almost certainly rules out a fracture.
Quick Facts
- Field
- Orthopedics, sports medicine, Physical medicine and rehabilitation, Family medicine
- Symptoms
- Swelling, bruising, pain
- Diagnosis
- Physical examination
- Differential
- Maisonneuve fracture, high ankle sprain
- Treatment
- Physical medicine and rehabilitation
Facts from the source article.
Lore & Background
Ankle sprains occur when excessive stress is placed on the ligaments of the ankle, often through movements such as turning and rolling of the foot. The most common type is an inversion sprain, where the foot rolls inward, damaging the lateral ligaments, particularly the anterior talofibular ligament. Eversion sprains, affecting the medial deltoid ligament, are less common, while high ankle sprains involve the syndesmotic ligaments above the ankle and occur from forceful outward twisting.
Diagnosis relies on medical history and the Ottawa ankle rule to differentiate sprains from fractures. Sprains are classified into three grades: Grade 1 involves mild damage without instability, Grade 2 is a partial tear causing looseness, and Grade 3 is a complete tear with joint instability. Bruising may occur around the ankle in more severe cases.
Initial treatment commonly follows the RICE protocol (rest, ice, compression, elevation), though its effectiveness is debated. Functional treatment, including range-of-motion exercises, strengthening, and balance training, is generally preferred over immobilization. Balance and neuromuscular training can reduce recurrence rates by up to 40–50 percent.
Reader's Guide
Ankle sprains are the most common injury in sports and among acute dance injuries, with inversion sprains accounting for 70–85% of cases. The injury results from excessive stress on ankle ligaments, often during explosive side-to-side motions in sports like basketball, tennis, and football. Diagnosis is aided by the Ottawa ankle rule, which has nearly 100% sensitivity for ruling out fractures. Treatment has evolved from strict RICE to functional rehabilitation emphasizing early movement, strengthening, and balance training. Chronic Ankle Instability (CAI) can develop if ligaments heal in a stretched position due to premature return to activity. Prevention strategies include bracing, which is more effective than taping in high-risk sports during the first 6–12 months. The condition's high prevalence and potential for long-term instability make proper management critical for athletes and active individuals.
Did You Know?
- Ankle sprains are the most commonly occurring injury in sports, especially in ball sports and racquet sports.
- Approximately 70–85% of ankle sprains are inversion injuries, affecting the lateral side of the ankle.
- Returning to activity before ligaments fully heal can lead to Chronic Ankle Instability (CAI).
- Balance and neuromuscular training can reduce recurrence rates of ankle sprains by up to 40–50 percent.
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