Ankle Sprain in South Korea: Symptoms, Causes & Treatment | aihealz
Podiatrymild
Ankle Sprain.Care & specialists in South Korea
In South Korea, ankle Sprain is managed by podiatrys. Ankle sprain is the most common musculoskeletal injury in active populations, with US emergency departments treating approximately 2 million cases per year (Waterman 2010). The lateral ligament complex — anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) — is involved in 85% of sprains, typically through an inversion mechanism when the foot rolls inward.
aliases · Ankle sprain (twisted ankle)· Twisted ankle· Rolled ankle· Entorse de cheville· reviewed May 14, 2026
EB
Reviewed by AIHealz Medical Editorial Board · PodiatryLast reviewed May 13, 2026
Ankle sprain (ICD-10: S93.4 sprain of ligaments of ankle) is an acute injury to one or more of the ankle ligaments produced by sudden mechanical loading beyond the ligament's tensile capacity. The most common form is the lateral (inversion) ankle sprain affecting the lateral ligament complex: anterior talofibular ligament (ATFL, injured in roughly 65-85% of cases), calcaneofibular ligament (CFL, 50-75%), and posterior talofibular ligament (PTFL, less than 10%). The medial (deltoid) ligament is injured less commonly through eversion mechanisms. High ankle sprains involve the distal tibiofibular syndesmosis (anterior inferior tibiofibular ligament and interosseous membrane) and typically result from forced external rotation in a fixed foot — a mechanism common in football, hockey, and skiing.
key facts
Prevalence
Approximately 2 million US emergency department visits annually (Waterman 2010); incidence roughly 2-7 per 1,000 person-years
Demographics
Highest rates in young adults aged 15-24; basketball, football, soccer, and running account for over half of sports-related cases
Avg. age
Peak age 15-19 in athletes; bimodal distribution with second peak in older adults from falls
Global cases
Estimated tens of millions of ankle sprains globally each year; under-reported because most are managed at home or in primary care
Specialist
Podiatry
§ 02
How you might notice it
The key symptoms of Ankle Sprain are: Sudden pain on the outer or inner side of the ankle immediately after a twisting injury during sport, walking on uneven ground, or a fall., Audible or palpable pop at the moment of injury in moderate to severe sprains., Localized tenderness directly over the lateral malleolus, the ATFL, the CFL, or the deltoid ligament depending on the mechanism., Swelling that develops within minutes to a few hours, often disproportionate to the apparent severity of injury., Ecchymosis (bruising) along the lateral or medial ankle and tracking distally to the foot over 24-72 hours., Inability to bear full weight immediately after the injury in moderate or severe sprains., Stiffness and reduced ankle range of motion, particularly inversion and dorsiflexion..
01Sudden pain on the outer or inner side of the ankle immediately after a twisting injury during sport, walking on uneven ground, or a fall.
02Audible or palpable pop at the moment of injury in moderate to severe sprains.
03Localized tenderness directly over the lateral malleolus, the ATFL, the CFL, or the deltoid ligament depending on the mechanism.
04Swelling that develops within minutes to a few hours, often disproportionate to the apparent severity of injury.
05Ecchymosis (bruising) along the lateral or medial ankle and tracking distally to the foot over 24-72 hours.
§ 03
How it’s diagnosed
diagnosis
Diagnosis is clinical. The history establishes the mechanism (inversion, eversion, external rotation), audible pop, immediate weight-bearing ability, prior ankle injuries, and footwear. Examination follows a structured approach: inspection for swelling, ecchymosis, and deformity; palpation along the lateral and medial malleoli, ATFL, CFL, deltoid ligament, syndesmosis, base of fifth metatarsal, navicular, and Achilles tendon; range of motion in dorsiflexion, plantarflexion, inversion, and eversion; and special tests including the anterior drawer test (ATFL integrity), talar tilt test (CFL integrity), squeeze test (syndesmosis), and external rotation test (syndesmosis). The Ottawa Ankle Rules identify the 15% of patients needing radiographs: bone tenderness at the posterior edge or tip of either malleolus, bone tenderness at the navicular or base of the fifth metatarsal, or inability to bear weight for four steps both immediately after injury and in the emergency department. Three-view ankle radiographs (AP, lateral, mortise) and dedicated foot radiographs (when foot tenderness is present) detect most fractures. MRI is reserved for suspected osteochondral injury, persistent symptoms past 6-8 weeks, suspected high ankle sprain not responding to standard care, or pre-operative planning. Ultrasound, increasingly used at the point of care, demonstrates ligament tears, hematoma, and dynamic instability. In chronic ankle instability, stress radiographs (Telos device) may quantify mechanical laxity but are less commonly used in modern practice.
Key tests
01
Ottawa Ankle Rules clinical assessmentIdentifies the 15% of patients who need radiographs to exclude fracture; sensitivity 98-100% for clinically significant fractures
02
Anterior drawer testAssesses ATFL integrity; positive when the talus translates anteriorly more than 5 mm or significantly more than the contralateral side
03
§ 04
Treatment & cost
medical treatments
✓POLICE protocol (first 72 hours)
✓Functional rehabilitation with structured physiotherapy
✓Removable ankle brace (lace-up or stirrup)
✓Short-course NSAIDs (3-5 days)
surgical options
Brostrom-Gould lateral ligament repairReturn to sport and stability in 80-90% of selected patients; recurrence under 10% at 5-10 years
Brostrom with internal brace augmentationReturn to sport in 85-95% in published series; allows earlier rehabilitation than open Brostrom alone
Syndesmotic screw or TightRope fixationRestoration of syndesmotic alignment in over 90%; suture button has lower rates of hardware removal compared with screws
Ankle arthroscopy for osteochondral lesionSymptomatic improvement in 70-85% for small lesions; larger lesions may need autologous chondrocyte implantation
§ 05
Causes & risk factors
known causes
Sudden inversion of the foot
The most common mechanism (85% of sprains). The foot rolls inward while planted, often when landing from a jump on uneven ground, stepping off a curb, or being stepped on by another athlete. The ATFL is the first ligament to fail; with greater force the CFL and then PTFL follow.
Forced external rotation with planted foot (high ankle sprain)
Common in football, hockey, and skiing when the foot is fixed and the body rotates outward. The distal tibiofibular syndesmosis is stretched or torn. Recovery is significantly longer than lateral sprains.
Eversion injury
Less common; the foot rolls outward stretching the deltoid ligament. Often associated with fibular fracture or syndesmotic injury. Requires careful clinical and radiographic evaluation.
Recurrent injury and chronic ankle instability
Up to 30% of first-time ankle sprains progress to chronic ankle instability. Mechanical instability (residual ligament laxity) and functional instability (impaired proprioception, neuromuscular control) both contribute. Inadequate initial rehabilitation is the strongest predictor.
Inappropriate footwear and uneven surfaces
High-heeled shoes, unsupportive footwear, and walking or running on uneven ground all raise the risk of inversion injury. Sport-specific footwear reduces incidence in basketball and indoor sports.
Underlying biomechanical risk factors
Cavus (high-arched) foot type, hindfoot varus, reduced ankle dorsiflexion, and proprioceptive deficits all raise inversion injury risk. Athletes with prior sprains carry markedly increased risk on subsequent loading.
risk factors
Previous ankle sprain
§ 06
Living with it
01Continue balance and proprioception training (wobble board, single-leg stance) two to three times per week, especially after a previous sprain.
02Wear sport-specific footwear in good condition; replace worn athletic shoes every 6-12 months.
03Use an ankle brace during high-risk sports (basketball, volleyball, soccer) for 6-12 months after a significant sprain.
04Maintain ankle dorsiflexion mobility with daily calf and ankle stretches.
05Strengthen peroneal, tibialis posterior, and intrinsic foot muscles as part of routine training.
06Use the FIFA 11+ warm-up or equivalent neuromuscular training programs that reduce lower-limb injuries by 30-40% in cohort studies.
recommended foods
•Adequate protein (1.0-1.4 g/kg/day) to support soft-tissue and ligament healing
Podiatric, sports medicine, or orthopedic referral is appropriate for severe (grade 3) sprains, syndesmotic injury, persistent symptoms past 6-8 weeks, recurrent sprains, chronic ankle instability, or suspected osteochondral injury. Specialists confirm diagnosis with ultrasound or MRI, structure return-to-sport progression, and consider surgery in refractory chronic instability.
01Chronic ankle instability with recurrent sprains and giving-way in 20-30% of cases, more common after inadequate initial rehabilitation.
02Osteochondral lesion of the talar dome, presenting with deep aching ankle pain and clicking; identified on MRI and treatable with arthroscopic procedures.
03Peroneal tendon pathology (tear, subluxation) — common after lateral ankle sprain and often missed initially; ultrasound or MRI confirms.
04Subtalar joint instability — under-recognized cause of persistent ankle and hindfoot pain after sprain.
05Anterolateral impingement from scar tissue or fibrosis in the lateral gutter; responds to corticosteroid injection or arthroscopic debridement.
Lateral ankle sprain (inversion)Most common form (85% of all ankle sprains). Foot rolls inward while planted, stretching or tearing the lateral ligaments (ATFL, CFL, PTFL). Pain and swelling concentrated over the lateral malleolus.
Medial ankle sprain (eversion)Less common (5-15%). Foot rolls outward, stretching or tearing the deltoid ligament. Often associated with fibular fracture or syndesmotic injury and warrants more careful evaluation.
High ankle sprain (syndesmotic)Injury of the distal tibiofibular syndesmosis. Forced external rotation in a planted foot. Pain superior to the lateral malleolus along the syndesmosis; squeeze and external rotation stress tests positive. Recovery typically 2-3x longer than lateral sprain.
Grade 1 sprain (mild)Microscopic ligament fiber damage. No mechanical instability on examination. Mild pain and swelling. Athletes return to sport within 1-2 weeks.
Grade 2 sprain (moderate)Partial ligament tear with mild to moderate instability on examination. Significant pain, swelling, ecchymosis. Return to sport 3-6 weeks.
Grade 3 sprain (severe)Complete ligament rupture with marked instability. Inability to bear weight, significant ecchymosis. Return to sport 6-12 weeks; some require surgical repair.
Living with Ankle Sprain
Timeline
Grade 1: pain settles within 5-7 days; full return to sport at 1-2 weeks. Grade 2: pain resolves over 2-3 weeks; full sport at 4-6 weeks. Grade 3: walking pain-free by 3-4 weeks; full sport at 8-12 weeks. High ankle sprain: walking by 3-6 weeks; full sport at 8-16 weeks or longer. Chronic ankle instability: progressive improvement with rehabilitation over 12-24 weeks.
Lifestyle
01Avoid premature return to high-risk activity before completing functional rehabilitation criteria.
02Wear a lace-up brace during cutting and jumping sport for at least 6 months after a significant sprain.
03Inspect playing surfaces for uneven terrain and remove tripping hazards at home.
04Maintain a sleep schedule and adequate recovery between training sessions.
05Track ankle stability and any episodes of giving-way; report to clinician if recurrent.
06Address foot type (cavus, hindfoot varus) with appropriate footwear and orthoses where indicated.
Daily management
01Ice the ankle for 10-15 minutes every 2-3 hours during the first 48-72 hours.
02Wear a compression bandage or brace during waking hours in the first 1-2 weeks.
Complementary approaches
Manual therapy and joint mobilizationTherapist-applied joint mobilization may improve dorsiflexion and reduce stiffness in the acute and subacute phases. Best used alongside functional rehabilitation rather than as standalone therapy.
Comprehensive return-to-sport progression with criteria-based clearanceFunctional return-to-sport tests (hop tests, side-to-side jumps, sport-specific drills) replace time-based clearance and reduce reinjury when meticulously followed.
Choosing a doctor
Choose a podiatrist or foot and ankle specialist experienced in functional rehabilitation, chronic ankle instability, and surgical reconstruction when indicated. Centers offering same-day ultrasound, MRI access, sports physiotherapy familiar with proprioception training, and outpatient ligament reconstruction provide the most complete care.
An ankle sprain is an injury to one or more of the ligaments that stabilize the ankle, most commonly the lateral ligaments (ATFL, CFL, PTFL). It typically results from rolling the foot inward, causing immediate pain, swelling, and reduced ability to bear weight on the outer side of the ankle.
How long does an ankle sprain take to heal?▾▴
Grade 1 sprains heal in 1-2 weeks. Grade 2 sprains take 2-6 weeks. Grade 3 sprains need 6-12 weeks with structured rehabilitation. High ankle (syndesmotic) sprains take 6-12 weeks or longer. Return to full sport is decided by functional testing rather than time alone.
Do I need an X-ray for my ankle sprain?▾▴
Apply the Ottawa Ankle Rules: an X-ray is needed if you cannot bear weight for four steps immediately after the injury and in the emergency department, or if there is bone tenderness over the malleoli, navicular, or base of the fifth metatarsal. About 85% of sprains do not need imaging.
Should I walk on a sprained ankle?▾▴
Walk within pain tolerance from day one — complete non-weight-bearing slows recovery. Use a brace or stirrup splint to protect the ankle. Crutches are used only if walking is severely painful. Early controlled weight-bearing is now the standard of care.
How do I know if my ankle is broken or sprained?▾▴
A fracture typically causes severe focal bone pain, inability to bear weight, and tenderness over a specific bony site (malleolus, fifth metatarsal, navicular). A sprain causes ligament tenderness and is often able to bear partial weight after a few minutes. The Ottawa Ankle Rules and an X-ray when indicated distinguish them.
What exercises help an ankle sprain?▾▴
Range-of-motion exercises (alphabet writing, ankle pumps), peroneal strengthening with resistance bands, calf stretching, single-leg balance, wobble board and BOSU training, and progressive sport-specific drills form the rehabilitation core. A physiotherapist guides progression over 4-8 weeks.
When can I return to sport after an ankle sprain?▾▴
Return to sport is guided by functional criteria: full pain-free range of motion, near-normal peroneal strength, single-leg balance equal to the uninjured side, ability to hop, cut, and pivot without pain or giving way, and clinician clearance. Typical timelines: grade 1, 1-2 weeks; grade 2, 3-6 weeks; grade 3, 6-12 weeks.
Should I ice an ankle sprain?▾▴
Yes. Apply ice for 10-15 minutes every 2-3 hours during the first 48-72 hours. Wrap ice in a thin towel to avoid direct skin contact. After the first 72 hours the benefit of icing decreases and progressive loading becomes more important.
Can a sprained ankle heal without treatment?▾▴
Mild grade 1 sprains often improve without medical care, but inadequately rehabilitated sprains carry a 20-30% risk of chronic ankle instability. Even mild sprains benefit from structured rehabilitation including balance training, which reduces recurrence by 35-50%.
What is a high ankle sprain?▾▴
A high ankle sprain involves the distal tibiofibular syndesmosis above the ankle joint, usually from forced external rotation in a fixed foot. Pain is located higher than the lateral malleolus. Recovery is significantly longer than lateral ankle sprains, typically 6-12 weeks or more.
Can ankle sprains recur?▾▴
Yes. Up to 30% of first-time sprains progress to chronic ankle instability with recurrent sprains and giving-way. The strongest predictor of recurrence is inadequate initial rehabilitation. Comprehensive proprioception training and ankle bracing during sport reduce recurrence substantially.
Do ankle braces help prevent sprains?▾▴
Yes. Lace-up braces worn during high-risk sports reduce recurrent sprains by approximately 40-50% in athletes with prior injury. They are recommended for at least 6 months after a significant sprain and during high-risk cutting and jumping activity.
What is the difference between sprain and strain?▾▴
A sprain is an injury to a ligament (the tissue connecting bones). A strain is an injury to a muscle or tendon (the tissue connecting muscle to bone). Ankle sprains involve the ankle ligaments; calf and Achilles injuries are usually strains. Treatment principles overlap but specific rehabilitation differs.
Can children get ankle sprains?▾▴
Yes. Children and adolescents commonly sprain ankles in sports and play. Skeletal immaturity sometimes leads to growth-plate fractures rather than pure ligament sprains, particularly in children under 12. Pediatric ankle injuries with significant swelling or persistent pain warrant X-rays.
Is surgery ever needed for an ankle sprain?▾▴
Surgery is reserved for chronic ankle instability after 6+ months of failed rehabilitation, unstable syndesmotic injuries, and significant osteochondral lesions. The Brostrom procedure restores lateral ankle stability in 80-90% of selected patients. Over 95% of acute sprains recover fully without surgery.
How can I prevent ankle sprains?▾▴
Maintain balance and proprioception training (wobble board, single-leg stance) two to three times per week. Wear sport-specific footwear in good condition. Use a lace-up brace during high-risk sports if you have a prior sprain. Maintain ankle dorsiflexion mobility and peroneal strength. Use FIFA 11+ or similar neuromuscular warm-up programs.
Why does my ankle keep rolling after a sprain?▾▴
Recurrent giving-way reflects chronic ankle instability — a combination of residual ligament laxity and impaired proprioception and neuromuscular control. Comprehensive rehabilitation focused on balance and peroneal strengthening typically resolves the problem; surgical reconstruction is reserved for refractory cases.
Can ankle sprains cause arthritis later in life?▾▴
Multiple severe sprains and chronic ankle instability can predispose to long-term ankle osteoarthritis through cartilage damage and altered joint mechanics. A single well-rehabilitated sprain has minimal long-term risk. Comprehensive rehabilitation and bracing after significant sprains reduce this risk.
Should I use a walking boot for an ankle sprain?▾▴
A walking boot is used for severe (grade 3) lateral sprains for the first 1-2 weeks and for high ankle sprains for 4-6 weeks. It allows protected weight-bearing while ligaments heal. Most grade 1 and 2 sprains are better managed with a removable brace and early functional rehabilitation.
Are NSAIDs safe for ankle sprains?▾▴
Short-course NSAIDs (3-5 days) are reasonable for acute pain and swelling and have not been shown to slow recovery in clinical trials. Long-term high-dose use is discouraged because of theoretical interference with soft-tissue healing. Paracetamol and topical NSAIDs are alternatives with less systemic exposure.
Can I sprain my ankle in non-sport activities?▾▴
Yes. Stepping off a curb, walking on uneven ground, slipping on ice, and falling on stairs are common non-sport causes. Older adults are particularly prone to sprains from falls and uneven surfaces. The rehabilitation and prevention principles apply equally to sport and non-sport sprains.
06Inability to bear full weight immediately after the injury in moderate or severe sprains.
07Stiffness and reduced ankle range of motion, particularly inversion and dorsiflexion.
08Sensation of the ankle giving way, especially on uneven surfaces or stairs, in recurrent or severe cases.
09Tenderness along the medial malleolus, base of the fifth metatarsal, navicular, or proximal fibula — important sites to assess for fracture per the Ottawa Ankle Rules.
10Persistent pain on functional activities (running, jumping, cutting) for weeks to months in poorly rehabilitated sprains.
early warning signs
•Mild ankle pain after a minor twisting injury that worsens over hours
•Brief 'giving way' sensation during sport followed by full recovery within minutes
•Recurrent mild ankle sprains in someone with no history of severe injury — early chronic ankle instability
•Reduced single-leg balance on the affected side compared with the contralateral side
•Subtle ankle stiffness in the morning that resolves with activity in chronic instability
● emergency signs
•Inability to bear weight on the injured ankle for four steps in the emergency department and immediately after the injury — apply Ottawa Ankle Rules and obtain radiographs
•Bony tenderness over the posterior edge or tip of either malleolus, the navicular, or the base of the fifth metatarsal — Ottawa Ankle Rules indication for X-ray
•Severe deformity, neurovascular compromise, or open injury — emergency department evaluation
•Numbness, tingling, or color change in the foot — exclude nerve or vascular injury
•Severe disproportionate pain with calf tenderness and swelling after immobilization — exclude deep vein thrombosis
Talar tilt testAssesses combined ATFL and CFL integrity; positive when inversion produces visible joint opening or excessive talar tilt compared with the other side
04
Squeeze test and external rotation stress test (syndesmosis)Identify high ankle sprain involving the distal tibiofibular syndesmosis
05
Three-view ankle radiograph (AP, lateral, mortise)Excludes fracture when Ottawa Ankle Rules positive; assesses mortise alignment and joint space
06
MRI of the ankleEvaluates osteochondral lesions, ligament tears, syndesmotic injury, and other soft tissue pathology when symptoms persist past 6-8 weeks
07
Musculoskeletal ultrasoundReal-time assessment of ligament integrity, hematoma, and dynamic instability; increasingly available at point of care
Outlook
Most ankle sprains have excellent outcomes with appropriate functional rehabilitation. Grade 1 sprains: full return to sport in 1-2 weeks, recurrence 5-15%. Grade 2: 2-6 weeks, recurrence 15-25%. Grade 3: 6-12 weeks, recurrence 25-35% without comprehensive rehabilitation. High ankle sprains: 6-12 weeks or longer with potential for chronic syndesmotic pain. Approximately 20-30% of all sprains progress to chronic ankle instability with recurrent sprains, persistent pain, and giving-way — strongly associated with inadequate initial rehabilitation. Predictors of poor outcome are prior sprain, persistent strength or balance deficit at return-to-sport, untreated osteochondral injury, and a high-volume cutting or jumping sport. Surgical lateral ligament reconstruction (Brostrom procedure) restores 80-90% of selected patients to sport. Long-term, multiple severe sprains predispose to ankle osteoarthritis — an additional reason for comprehensive initial rehabilitation.
non-modifiable
Single biggest predictor of future sprain — recurrence risk roughly 2-3x higher than baseline. Driven by residual ligament laxity, proprioceptive deficit, and altered neuromuscular control after the index injury.
Participation in cutting/jumping sportsmodifiable
Basketball, football, soccer, volleyball, and racquet sports show the highest incidence. Up to half of all basketball injuries are ankle sprains.
Female sex in basketball and similar sportsnon-modifiable
Female athletes have slightly higher incidence in cutting and jumping sports, partly because of biomechanical and hormonal factors. The difference is smaller than for ACL injuries.
Cavus (high-arched) foot typenon-modifiable
High-arched feet predispose to inversion through reduced subtalar mobility and altered ground contact. Hindfoot varus alignment compounds the risk.
Reduced ankle dorsiflexionmodifiable
Limited ankle dorsiflexion alters landing mechanics and raises injury risk. Calf and ankle mobility programs reduce sprain incidence in athletes.
Poor proprioception or balance deficitmodifiable
Reduced single-leg balance on the affected side predicts both initial and recurrent sprains. Balance and proprioception training (including wobble boards and BOSU) reduces recurrence by approximately 35-50%.
Inadequate footwear for the activitymodifiable
Non-sport-specific shoes, worn footwear, and high heels raise inversion injury risk. Court shoes provide better lateral support than running shoes for cutting sports.
Calcium and vitamin D-rich foods for bone health during reduced weight-bearing
•Excessive alcohol — impairs balance and increases re-injury risk during recovery
•Tobacco use — impairs ligament and soft-tissue healing
•Long-term high-dose NSAIDs during the healing phase — theoretical impairment of soft-tissue repair
•Excessive caffeine intake that disrupts sleep and recovery
Long-term ankle osteoarthritis in patients with multiple severe sprains and chronic instability.
choosing the right hospital
01Emergency department able to apply Ottawa Ankle Rules and provide radiographs when needed
02Sports physiotherapy team experienced in functional rehabilitation and balance training
03Musculoskeletal ultrasound and MRI access for persistent or complex cases
04Foot and ankle orthopedic surgical service for chronic instability or osteochondral lesions
05Bracing and orthotic services for return-to-sport support
Essential facilities
Emergency departments and urgent care centersSports medicine clinics with same-day imagingOutpatient physiotherapy with sport-specific rehabilitationFoot and ankle surgical centersOrthotic and bracing services
03Elevate the foot above heart level when seated or sleeping for the first 3-5 days.
04Perform the prescribed rehabilitation exercises on alternate days.
05Wear lace-up brace during sport for at least 6 months after a significant sprain.
06Track giving-way episodes and report any to clinician at follow-up.
Exercise
Days 0-3: weight-bearing as tolerated, gentle range of motion (alphabet writing), seated dorsiflexion stretches. Days 3-14: progressive range of motion, theraband peroneal strengthening, double-leg balance, stationary cycling. Weeks 2-4: single-leg balance, wobble board, BOSU, progressive sport-specific drills. Weeks 4-8: hopping, cutting, sport-specific reintroduction. Return-to-sport based on functional criteria, not time alone.