Ankle sprain

An ankle sprain is a very common injury. ^{1, 2} A sprain can heal well, but some people continue to experience pain, a feeling of weakness, or a sensation that their ankle is giving way. A review of studies following a first lateral sprain found that, one year later, 8.1% of people experienced instability (a feeling that the ankle gives way), 6.7% had pain, and 15.8% suffered a new sprain. ³ Exercises and a gradual return to activities are part of rehabilitation—that is, the care that helps you regain your abilities. This guide explains how to recognize a sprain, when to seek medical attention, and how to resume your activities. The physical therapists at Physioactif can support you through this process. For an overview of conditions affecting this area, see our comprehensive guide on foot and ankle pain.

What exactly is an ankle sprain?

An ankle sprain occurs when you stretch or tear the ligaments that stabilize the joint. Ligaments are bands of strong tissue that connect bones to one another. A lateral sprain, which affects the outer ligaments, is the most common type of ankle sprain ¹. Among American college athletes in basketball, women’s volleyball, and women’s gymnastics, the outer ligaments were involved in 77.1% of sprains ⁴. This percentage applies to these college sports. ²

The ankle has three main external ligaments. The anterior talofibular ligament (ATFL) is the one most commonly injured. It provides stability when your foot rolls inward. The calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL) complete this stabilization system.

Ligaments limit excessive movement in a joint. Unlike muscles, they do not produce movement by contracting. Recovery depends largely on the severity of the tear. Unlike Achilles tendon tears, ankle sprains involve ligaments. A tendon connects a muscle to a bone.

How does an ankle sprain happen?

A sprain occurs when your foot twists beyond its normal range of motion. The most common type of sprain is an inversion sprain, in which your foot twists inward. This happens when you step on an uneven surface or land awkwardly after a jump.

Inversion—when your foot twists inward—can injure the ligaments on the outside of the ankle. Eversion—when your foot twists outward—can injure the deltoid ligament on the inside of the ankle.

Common circumstances for a sprain include:

• Walking on uneven ground
• Landing awkwardly after a jump (especially during intense sports activities)
• Changing direction quickly in a sport
• Falling off a step or curb

Athletes who participate in sports involving repeated jumping, such as basketball or volleyball, are frequently at risk of ankle sprains. A review of numerous studies found that the highest incidence of new sprains occurs in indoor and enclosed-field sports ¹. In the university study, sprains often occurred during contact while jumping in basketball or volleyball ⁴. These sports also place stress on the tendon located beneath the kneecap. Persistent pain associated with this tendon may indicate patellar tendinopathy.

A sprain usually occurs as a result of a sudden awkward movement or a fall. Pain that develops gradually should also be evaluated. It may be caused by Achilles tendinopathy—persistent pain in the tendon behind the ankle—or by another condition.

Ankle sprains are not uncommon. In a study conducted among military recruits in training, the ankle and foot region was the most frequently injured part of the body, ahead of the knee. ⁵

What are the different grades of ankle sprains?

The three grades of sprains describe a stretch with small tears, a partial tear, or a complete tear of the ligament.

• Grade I (mild): A sprain with microscopic tears too small to be seen with the naked eye. Pain and swelling are usually mild, with no instability on examination.
• Grade II (moderate): partial tear, with pain, swelling, and ecchymosis—that is, a bruise under the skin. An examination may reveal some instability: the ankle is less stable.
• Grade III (severe): Complete tear of the ligament, with significant instability on examination. Pain and swelling may be severe. Recovery generally takes longer than for a mild sprain.

L'intensité de la douleur ne suffit pas à déterminer la gravité de l'Sprain. Une Sprain grave peut aussi toucher des nerfs; le professionnel vérifie donc la sensibilité du pied. Une douleur faible ne permet pas d'écarter une rupture complète. L'examen sert à déterminer le grade et à rechercher d'autres blessures. Source : Manuel Merck sur l'Sprain de cheville⁶.

What are the symptoms of a sprain and how can you tell it apart from a fracture?

A sprain can cause pain, swelling, and difficulty walking; examining the foot and ankle helps distinguish it from a fracture, which can produce the same symptoms. The Ottawa Rules are screening criteria that help healthcare professionals determine whether an X-ray—an X-ray image of the bones—is necessary. A negative result greatly reduces the likelihood of a fracture, though it does not rule it out entirely. ^{7, 8}

Typical symptoms of a sprain

Typical symptoms include immediate pain after the injury, especially on the outside of the ankle. Swelling can appear quickly or within the following hours. You might also notice bruising, have difficulty walking, and feel instability.

Immediate symptoms include:

• Sharp pain at the time of injury
• A sensation that something snapped, sometimes accompanied by a crackling sound
• Difficulty putting weight on the foot

In the hours that follow, the following may occur: increasing swelling, redness, and warmth due to the body’s reaction to the injury, and bruising if small blood vessels have been affected. A minor sprain may not cause visible swelling. The bruise may move down toward the foot due to gravity. After an injury, heel pain should also be evaluated if it is severe or prevents you from bearing weight. Outside of an accident, pain under the heel can be caused by plantar fasciitis, which affects the band of tissue under the foot.

How to Tell the Difference Between a Sprain and a Fracture

The healthcare professional examines your ankle, the bones of your foot, and your ability to walk. Specific pain in a bone or an inability to bear weight warrants special attention. The Ottawa Rules link the site of pain to specific points to be examined; they are not limited to any pain in a bone.

Chez l'adulte après une blessure, les règles d'Ottawa⁹ recommandent une radiographie dans les situations suivantes :

• Pain around the bony prominences of the ankle, accompanied by at least one of the following signs: pain upon touch along the posterior edge of the last 6 centimeters or at the tip of one of these bony prominences; inability to take four steps immediately after the injury and during the examination.
• Pain in the middle of the foot, accompanied by at least one of the following symptoms: pain upon touch over the navicular bone or along the inner edge of the foot; pain at the base of the fifth metatarsal bone or at the bump on the outer edge of the foot; inability to take four steps immediately after the injury and during the examination.

These checks require careful examination. They are not intended to help you rule out a fracture on your own at home.

Both a sprain and a fracture can allow the person to take a few steps or prevent them from walking. The table summarizes factors that help guide the examination, though it does not, on its own, establish a diagnosis.

Walking alone is not enough to rule out a fracture. Seek medical attention immediately if you cannot put weight on the leg.

After an injury, go to the emergency room if your ankle is misshapen, if you heard a popping sound, if your foot feels numb or tingly, or if the skin on your foot turns blue, gray, or cold. Severe pain or a complete loss of mobility also requires immediate evaluation.

Demandez un avis médical urgent si la douleur est forte ou augmente, si l'enflure ou les bleus sont importants ou augmentent, si vous ne pouvez pas prendre appui ou faire quelques pas, ou si la cheville est très raide ou difficile à bouger. Une forte fièvre, une sensation de chaud ou de froid, ou des frissons justifient aussi cet avis. Consultez également si les soins à domicile n'apportent pas d'amélioration. Source : conseils du NHS après une Sprain ou une élongation¹⁰.

When to consult a physiotherapist for an ankle sprain?

Physical therapy treatment can begin within the first few days after a sprain, once any symptoms requiring urgent medical attention have been addressed. Contact the clinic to find out when the next available appointment is.

Au Québec, vous pouvez consulter directement un physiothérapeute en clinique privée. Certains contrats d'assurance demandent toutefois une prescription pour le remboursement; vérifiez vos conditions. L'OPPQ explique l'accès et les assurances¹¹. Si votre physiothérapeute détecte une complication, il vous orientera vers le bon professionnel. Pour Learn more sur le rôle de la physiothérapie, consultez notre guide complet.

During your first consultation, your physiotherapist will:

• Assesses the severity of the sprain (grade I, II or III)
• Checks for signs of a fracture and refers you for a medical evaluation or X-ray if necessary
• Establishes a tailored treatment plan

Seeking early medical advice can help you avoid common mistakes, such as resting too much or resuming activity too quickly. A healthcare professional can help you protect your ankle and gradually resume movement based on your tolerance. If immobilization is prescribed, follow their instructions. An examination of the lateral ligaments may be more accurate four to five days after the injury, once the initial swelling has subsided. However, this never justifies delaying care if there are signs of a fracture or a medical emergency. ²

How does physiotherapy treat an ankle sprain, and is it effective?

Physical therapy for ligament pain helps restore mobility after a sprain through progressive exercises, guided movements, and advice on returning to activity. This treatment can improve mobility and function, relieve pain, and reduce the risk of another sprain.

Effectiveness demonstrated by research

The practice guidelines recommend exercises and a return to activities with ankle support as needed, rather than solely passive treatment received without active participation. ² Gentle movements performed by the physical therapist can improve ankle mobility and reduce pain in the short term. The guide recommends combining these with exercises. The value of additional supervision varies depending on the individual and the program; patients with severe sprains may benefit more from it.

Le physiothérapeute adapte les exercices à la gravité de l'Sprain, à la stabilité de la cheville et à votre capacité à sentir sa position, appelée Proprioception. Il tient aussi compte de vos activités, de vos inquiétudes et des exercices que vous arrivez à faire à domicile. La quantité et la difficulté des exercices évoluent avec vos symptômes. Une synthèse de 2022 confirme un risque moindre de nouvelle Sprain avec les programmes d'exercices, mais ne détermine pas un programme ou une quantité idéale pour tout le monde. Source : Wagemans et ses collègues¹².

Dans un essai auprès de 101 personnes avec une Sprain de grade I ou II, des exercices commencés pendant la première semaine ont amélioré les capacités aux semaines un et deux, comparativement aux soins usuels. La douleur et l'enflure n'étaient pas différentes entre les groupes. Source : essai de Bleakley et ses collègues¹³.

How Does the Treatment Work?

The physical therapist helps you regain functional movement and adjust your activities during recovery. He or she works with you to address stiffness, strength, ankle control, and any fears that limit your movement.

Your body repairs tissue after an injury. Inflammation is part of this repair process. It is the body's response to the injury. During recovery, the professional assesses several factors:

• Concerns or fears
• The number and difficulty of the activities
• Joint or muscle stiffness

The goal is to support your recovery while allowing the tissues to heal. To better understand the mechanisms of pain and how to manage it, check out our guide on chronic pain.

Protection begins after the injury and is intended to manage pain and swelling. It may include a bandage, a splint to support the ankle, or crutches, depending on the examination. The PEACE and LOVE guide provides advice on protection and a gradual return to activity.

Vous pouvez utiliser une poche froide enveloppée dans une serviette, jusqu'à 20 minutes à la fois, pour le confort. La glace ne remplace pas la reprise adaptée des mouvements. Demandez conseil avant son utilisation si vous avez un problème de sensibilité ou de circulation. Le NHS décrit les premiers soins¹⁰.

Many people take anti-inflammatory pills after a sprain. They relieve pain and swelling, but the practice guidelines on sprains urge caution: these medications may slow down the natural healing process. A review of studies on fractures also found an association between these medications and delayed or absent bone healing in adults. The results were inconclusive for low doses or short-term use. This study focused on bone and does not prove the same effect on ligaments. Your pharmacist or doctor can help you choose an appropriate medication, dose, and duration of treatment. ²¹⁴

Recovery of mobility and strength begins gradually, depending on the level of pain and the recommended precautions. It includes ankle movements, followed by exercises using appropriate resistance.

Balance training can begin early on, provided the patient can tolerate it. It then progresses to everyday activities and sports. It is not necessary to automatically wait three weeks before starting.

Your return to activity follows a structured, multi-phase progression, with more challenging exercises based on your tolerance and your goals for returning to activity.

Votre physiothérapeute vous conseille sur l'utilisation de béquilles, d'une attelle ou d'un bandage au besoin. Découvrez comment la physiothérapie traite les douleurs au pied et à la cheville, et voyez notre page sur le traitement de l'Ankle sprain en clinique.

What exercises help with recovery from an ankle sprain?

Mobility, strength, and balance exercises help with recovery from an ankle sprain. They progress to running and changes of direction once you can control these movements.

Proprioception and balance exercises help improve ankle control and reduce the risk of another sprain in people who have already been injured. ¹⁵

Proprioception allows you to sense the position of your ankle without looking at it. Exercises on an unstable surface or with your eyes closed increase the difficulty. Start with a support nearby and progress as your control improves. To restore ankle stability, a single-leg balance exercise is often part of the proprioceptive program. If you have also suffered a calf strain, the program must take this muscle injury into account. The preventive benefit observed for ankle sprains does not guarantee a reduction in calf strain recurrences.

Can you treat an ankle sprain on your own?

What Self-Treatment Can Do, and Its Limitations

Home care may be sufficient for a mild sprain, after checking for signs that warrant a medical consultation. Initial protection, tolerated movements, and progressive exercises are part of this approach. Proprioceptive training reduces the risk of re-injury in people who have already been injured, with a reduction of about one-third in recurrence rates according to a review of trials. ¹⁵ This translates to about one-third fewer new sprains than in the comparison groups, though individual outcomes cannot be guaranteed.

Dans un essai auprès de 522 sportifs, un programme d'équilibre de huit semaines à domicile, ajouté aux soins usuels, a réduit les nouvelles entorses à un an : 22 % contre 33 % avec les soins usuels seuls. Le programme n'était pas supervisé. Source : Hupperets et ses collègues¹⁶.

La revue Cochrane de 2001 trouvait surtout un bénéfice pour les supports de cheville, avec des preuves plus limitées pour les exercices d'équilibre.¹⁷ Elle a été retirée en 2011 parce qu'elle était trop ancienne¹⁸. Les études plus récentes citées ici apportent des données favorables aux exercices.

The Role of the Physiotherapist

The physical therapist assesses the stability of your ankle and any difficulties you may have with movement. He or she checks for signs of a fracture or nerve damage and refers you to the appropriate specialist if necessary. Together, you and the physical therapist will develop a progressive exercise program tailored to your abilities and goals.

A Combined Approach

Assessments and at-home exercises can complement each other. Follow-up visits are used to monitor your progress and adjust the program as your symptoms, activities, or challenges change.

How long does it take to recover from an ankle sprain?

La récupération d’une Sprain de cheville peut prendre environ deux semaines pour une petite Sprain et de six à douze semaines pour une Sprain plus sévère. Ces repères décrivent le programme de reprise des activités; ils ne garantissent pas une réparation complète des ligaments à une date précise. Source : American Academy of Orthopaedic Surgeons¹⁹.

Timeframes to be adjusted based on your situation

A Grade I sprain usually heals faster than a Grade II or III sprain. Some severe injuries can take several months to heal. The physical therapist will outline the steps and adjust the timeline based on your progress.

Several factors influence the duration:

• The severity of the injury (grade)
• Progress in your exercises and the activities you'd like to resume
• Your injury history

Don't base your return to sports solely on the absence of pain. Movement tests assess your strength, balance, and ability to perform the movements required for your sport. The professional will also take your confidence into account. If the pain persists, if your ankle remains unstable, or if you don't see any progress, consult a physical therapist.

The recovery times for other injuries do not automatically apply to your ankle. A meniscal tear, which affects a cartilage pad in the knee, or a hip fracture requires different types of care and a different recovery process.

Not all ankle pain is caused by the ligament. Nerves pass through a tunnel inside the ankle and can become compressed there. Numbness or tingling requires further evaluation. After a recent injury, these symptoms require urgent medical attention, as noted above. ²⁰

How can you prevent another ankle sprain?

Balance and ankle stability exercises reduce the risk of another sprain. Continue the agreed-upon program even as the pain subsides, following the steps outlined with your healthcare professional. An ankle that still gives way requires follow-up care. In a review of studies, this sensation persisted in 8.1% of people one year after their first lateral sprain. ³

Le retour à l'activité se planifie. Dans une étude auprès de 1 296 recrues militaires masculines de 17 à 28 ans, les semaines comprenant le plus grand nombre d’heures d’entraînement vigoureux, de course et de Walking étaient associées aux taux de blessure les plus élevés⁵. Cette association ne prouve pas à elle seule la cause des blessures. En pratique, la reprise par étapes permet d'ajuster la durée et la difficulté des activités à votre tolérance.⁵

A previous sprain increases the risk of another one. Balance exercises and monitoring for persistent instability therefore remain important even after the pain has subsided. To learn more about another common joint condition, see our guide on knee osteoarthritis.

Tips for preparing to resume activities:

• Follow the steps outlined in your program and have it adjusted as needed
• Continue doing balance exercises after the pain subsides
• Strengthen the muscles around the ankle, including the calf muscles which play a stabilizing role.
• Gradually work up to the exercises during your warm-up
• Portez des souliers appropriés adaptés à votre activité et confortables

Taping—a supportive adhesive bandage—or an orthosis, a brace worn around the ankle, can reduce the risk of another sprain during sports. These aids complement the exercises. ² This guide does not recommend a specific type of shoe to prevent sprains. For athletes, a gradual return to activity helps them adjust their exertion levels. The principle of gradual progression also applies after a knee sprain, with a program tailored to this specific injury.

What are the key takeaways about ankle sprains?

The key points are to check for signs of a medical emergency, resume movement gradually, and do balance exercises to reduce the risk of another sprain. A sprain can be treated, and most people can resume their activities. The absence of pain alone is not enough to determine when to return to sports; strength, balance, and control of movement are also important.

For other foot and ankle conditions, see our guides on Morton's neuroma, hallux valgus, or metatarsalgia.

References

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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.