An ankle sprain is a soft-tissue injury involving one or more of the ligaments that support the ankle joint. It usually occurs when the foot twists or rolls unexpectedly, stretching or tearing the ligaments. The lateral ligaments on the outside of the ankle are most commonly affected. Although most sprains heal with proper care, untreated injuries can lead to chronic instability or post-traumatic arthritis.
How Common It Is and Who Gets It? (Epidemiology)
Ankle sprains are among the most common musculoskeletal injuries worldwide, accounting for up to 30% of all sports-related injuries. They frequently occur during activities that involve jumping, running, or sudden directional changes, such as basketball, soccer, and volleyball. Young adults and athletes are particularly at risk, but sprains can occur during routine activities such as stepping off a curb or missing a stair.
Why It Happens – Causes (Etiology and Pathophysiology)
Ankle sprains occur when the ligaments that stabilize the joint are stretched beyond their normal limits.
- Inversion injuries (foot turning inward) damage the lateral ligament complex—especially the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
- Eversion injuries (foot turning outward) may injure the medial deltoid ligament and are less common.
- High ankle sprains (syndesmotic injuries) affect the ligaments between the tibia and fibula.
The injury leads to microscopic or macroscopic tears, inflammation, and sometimes bleeding into the joint. Incomplete healing can cause persistent looseness, leading to recurrent sprains.
How the Body Part Normally Works? (Relevant Anatomy)
The ankle is stabilized by several key ligaments:
- Lateral ligaments: ATFL, CFL, and posterior talofibular ligament (PTFL)
- Medial ligaments: The deltoid ligament complex
- Syndesmosis: Connects the tibia and fibula bones
In addition, peroneal tendons on the outside of the ankle help dynamically stabilize the joint during movement.
What You Might Feel – Symptoms (Clinical Presentation)
Common symptoms include:
- Pain on the outer side of the ankle (lateral sprain)
- Swelling and bruising around the ankle and foot
- Tenderness when pressing on the injured area
- Difficulty bearing weight or walking normally
- A feeling that the ankle “gives way” when standing or moving
- Stiffness and reduced range of motion
Mild sprains cause minor swelling and tenderness, while severe sprains result in significant pain, instability, and an inability to bear weight.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis begins with a medical history and physical examination.
- Provocative tests: The anterior drawer and talar tilt tests help evaluate ligament laxity.
- Ottawa Ankle Rules: Used to decide when X-rays are necessary—radiographs are recommended if there is bone tenderness or inability to bear weight.
- MRI or ultrasound: May be ordered if chronic instability, tendon tears, or cartilage injuries are suspected.
Classification
Ankle sprains are graded based on severity:
- Grade I: Ligament stretching without tearing; mild pain and swelling.
- Grade II: Partial ligament tear with moderate swelling, bruising, and difficulty bearing weight.
- Grade III: Complete tear of one or more ligaments with severe pain, instability, and inability to bear weight.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can mimic ankle sprains include:
- Fractures of the ankle or foot
- Peroneal tendon tear
- Syndesmosis (high ankle) injury
- Osteochondral lesion of the talus
- Subtalar joint sprain or midfoot injury.
Treatment Options
Non-Surgical Care
Most ankle sprains heal without surgery. Early functional treatment is preferred over prolonged immobilization.
- Rest, Ice, Compression, Elevation (RICE): Used during the first 48 hours to control pain and swelling.
- Functional support: Braces or elastic bandages support healing while allowing gentle motion.
- Physical therapy: Gradual rehabilitation focuses on restoring range of motion, strength, and balance.
- Early weight-bearing: Encouraged as tolerated to promote faster recovery.
- Medications: Anti-inflammatory drugs help manage pain and swelling.
Surgical Care
Surgery is rare and reserved for:
- Chronic instability after repeated sprains
- Severe ligament ruptures not responsive to conservative treatment
The Broström repair is a common procedure that restores ligament stability and prevents future sprains.
Recovery and What to Expect After Treatment
Recovery depends on the injury’s severity:
- Grade I: 1–2 weeks for full recovery
- Grade II: 4–6 weeks
- Grade III: 8–12 weeks or more
Physical therapy plays a vital role in rehabilitation. Patients start with gentle motion exercises, followed by strengthening, proprioception (balance) training, and sport-specific drills. Most individuals return to normal activities within 2–3 months.
Possible Risks or Side Effects (Complications)
Complications may include:
- Chronic ankle instability
- Recurrent sprains due to incomplete ligament healing
- Peroneal tendon inflammation or tears
- Persistent pain from cartilage injury
- Post-traumatic arthritis in longstanding or untreated cases.
Long-Term Outlook (Prognosis)
With proper treatment and rehabilitation, most patients make a full recovery. Recurrent sprains are preventable through strengthening and balance training. Severe sprains or delayed rehabilitation increase the risk of long-term instability or arthritis.
Out-of-Pocket Costs
Medicare
CPT Code 27695 – Broström Repair (Primary Ligament Repair): $114.63
CPT Code 27698 – Revision or Reconstruction (if previous repair failed): $149.59
Medicare Part B covers 80% of the approved amount for these procedures once the annual deductible has been met. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield typically cover the remaining 20%, leaving most patients with little to no personal expense for Medicare-approved treatments. These supplemental plans are designed to work alongside Medicare, filling any coverage gaps for coinsurance or copayments.
If you have Secondary Insurance such as an Employer-Based Plan, TRICARE, or Veterans Health Administration coverage, it acts as a secondary payer after Medicare. These plans often cover remaining costs, including small deductibles that usually range from $100 to $300 depending on your plan and provider network.
Workers’ Compensation
If your ankle sprain occurred while performing job-related duties, Workers’ Compensation will pay for all medical expenses related to diagnosis, surgery, and rehabilitation. You will not have any out-of-pocket costs since the employer’s insurance carrier covers the full amount.
No-Fault Insurance
If your ankle sprain resulted from an automobile accident, No-Fault Insurance will generally cover the full cost of treatment, including surgery and physical therapy. The only possible out-of-pocket cost may be a small deductible or co-payment, depending on your policy.
Example
Emily Johnson suffered a severe ankle sprain that did not improve with conservative treatment. She underwent a Broström repair (CPT 27695) with an estimated Medicare out-of-pocket cost of $114.63. Because Emily had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses.
Frequently Asked Questions (FAQ)
Q. How can I tell if my high ankle sprain is severe?
A. Severe high ankle sprains may involve an inability to walk, intense pain with minimal movement, and significant swelling or bruising. An MRI or X-ray may be needed for diagnosis.
Q. Do high ankle sprains require surgery?
A. Surgery is only needed in severe cases where there is significant ligament damage or instability in the ankle joint. A doctor will assess whether surgical intervention is necessary.
Q. Can I walk on a high ankle sprain?
A. Walking may be possible with mild sprains, but moderate to severe sprains require rest, bracing, or crutches to avoid further injury.
Q. What types of rehabilitation exercises help with high ankle sprains?
A. Rehabilitation exercises include range-of-motion movements, resistance band exercises, balance training, and strengthening exercises for the lower leg and foot.
Q. How can I reduce swelling in a high ankle sprain?
A. Swelling can be managed by following the RICE protocol: Rest, Ice, Compression, and Elevation. Anti-inflammatory medication may also help.
Q. When should I see a doctor for a high ankle sprain?
A. You should see a doctor if you experience severe pain, difficulty walking, excessive swelling, or if symptoms do not improve within a few days of home treatment.
Q. What is a high ankle sprain?
A. A high ankle sprain, also known as a syndesmotic ankle sprain, involves injury to the ligaments connecting the tibia and fibula above the ankle joint.
Q. How does a high ankle sprain differ from a common ankle sprain?
A. Unlike common lateral ankle sprains caused by inward twisting, high ankle sprains result from external rotation of the foot and leg.
Q. What are common causes of high ankle sprains?
A. High ankle sprains often occur from external rotation injuries, such as when the foot is forced outward while the leg remains stationary.
Q. How is a high ankle sprain diagnosed?
A. Diagnosis involves clinical tests like the ‘squeeze’ test, imaging studies such as X-rays, ultrasound, or MRI to assess ligament damage.
Q. What is the typical treatment for a high ankle sprain?
A. Treatment may include rest, icing, compression, elevation, and in severe cases, surgical intervention to stabilize the ankle joint.
Q. How long is the recovery period for a high ankle sprain?
A. Recovery can range from a few days to six months, depending on the severity of the injury and adherence to rehabilitation protocols.
Q. Are there any complications associated with high ankle sprains?
A. Potential complications include persistent pain, instability, and an increased risk of re-injury if not properly treated.
Q. Can high ankle sprains be prevented?
A. Preventative measures include proper training, strength exercises, wearing appropriate footwear, and avoiding activities that place excessive stress on the ankle ligaments.
Q. Can I walk on a sprained ankle?
A. Mild sprains may allow limited walking, but severe injuries require crutches or bracing to prevent further damage.
Q. How long should I ice my ankle?
A. Apply ice for 15–20 minutes every 1–2 hours during the first two days after injury.
Q. Do ankle sprains always need X-rays?
A. Not necessarily. X-rays are taken only if there is bone tenderness or inability to bear weight.
Q. When can I return to sports?
A. Return to play when you have full motion, strength, and stability, and your doctor approves.
Q. Can ankle sprains lead to arthritis?
A. Yes, repeated sprains or poorly healed injuries can lead to chronic instability and arthritis over time.
Summary and Takeaway
Ankle sprains are extremely common injuries that occur when the ligaments around the ankle are stretched or torn. Most recover fully with early treatment, proper bracing, and a structured rehabilitation program. Prompt care and prevention strategies—such as balance exercises and supportive footwear—reduce the risk of chronic problems and future sprains.
Clinical Insight & Recent Findings
A 2025 systematic review and meta-analysis in Sports identified key risk factors for ankle sprains among soccer players. Previous sprains were the strongest predictor of future injuries, emphasizing the need for comprehensive rehabilitation.
Other risk factors included elevated body mass index (BMI), poor hip strength, and match congestion. The study concluded that maintaining muscular balance, improving proprioception, and following evidence-based prevention programs significantly reduce recurrence rates. (“Study on risk factors for ankle sprains in soccer players – see PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Ankle sprains are typically treated by orthopedic foot and ankle surgeons, sports medicine specialists, or podiatrists. Physical therapists guide rehabilitation, and athletic trainers assist with prevention and return-to-sport programs.
When to See a Specialist?
See a doctor if you have persistent pain, severe swelling, inability to bear weight, or if symptoms don’t improve after a few days of home care.
When to Go to the Emergency Room?
Go to the emergency room if you experience sudden severe pain, visible deformity, or inability to walk immediately after the injury. These may indicate a fracture or high ankle sprain.
What Recovery Really Looks Like?
Expect gradual improvement over several weeks. Mild sprains heal quickly, but severe injuries require longer rehabilitation. Temporary swelling and stiffness are normal. Consistent therapy and strengthening exercises are key to preventing re-injury.
What Happens If You Ignore It?
Ignoring an ankle sprain can lead to incomplete healing, chronic instability, or arthritis. Recurrent sprains are common in untreated cases and may require surgery later on.
How to Prevent It?
- Warm up before exercise
- Strengthen ankle and leg muscles
- Perform balance and proprioception exercises
- Wear properly fitting, supportive footwear
- Use taping or bracing if you’ve had prior sprains.
Nutrition and Bone or Joint Health
A diet rich in protein, calcium, and vitamin D supports ligament and bone repair. Omega-3 fatty acids help reduce inflammation and speed recovery.
Activity and Lifestyle Modifications
Avoid uneven surfaces, wear supportive shoes, and increase activity levels gradually. Incorporating ankle-strengthening and balance exercises into your routine helps prevent future injuries.
Dr. Mo Athar
