Ankle Sprain.Care & specialists in New Zealand

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.

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.

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.

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.

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.

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.

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.

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.

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%.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.