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Sprained Ankle

Ankle sprains are one of the most common sports injuries. A sprain occurs when the ligaments that support the ankle stretch or tear, which can weaken the joint and cause pain, swelling, and instability. Treatment and recovery time depend on the severity of the sprain and how many ligaments are affected.

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What is an ankle sprain?

A ligament is a strong band of fibrous tissue that connects bones and helps stabilize a joint. When the ankle twists, turns, or rolls beyond its normal range of motion, the ligaments can stretch or tear, resulting in a sprain.

Most ankle sprains occur from an inversion injury, when the foot rolls inward and the ligaments on the outside of the ankle are overstretched. The most commonly affected ligaments are:

  • Anterior talofibular ligament (ATFL)
  • Calcaneofibular ligament (CFL)
  • Posterior talofibular ligament (PTFL)

These ligaments may be injured individually or together.

Less commonly, the foot turns outward in an eversion injury, causing a medial ankle sprain. This type of sprain affects the deltoid ligament, which stabilizes the inside of the ankle.

Symptoms of an ankle sprain

Symptoms of an ankle sprain vary depending on the severity of the injury. Mild sprains may cause tenderness and discomfort when walking, while more severe injuries can cause persistent pain that worsens with standing or movement.

Other symptoms may include:

  • Tenderness around the ankle
  • Bruising
  • Swelling
  • Hearing or feeling a pop in the ankle joint
  • Reduced ankle stability

Grades of an ankle sprain

Doctors classify ankle sprains into three grades based on the severity of ligament damage.

A grade 1 ankle sprain is mild and occurs when a ligament is stretched but not torn. Symptoms typically include mild swelling, tenderness, and discomfort with movement. Most people can still bear weight and walk with minimal difficulty.

Recovery usually takes 1 to 3 weeks.

A grade 2 sprain involves a partial tear of a ligament. Pain, swelling, bruising, and tenderness are more noticeable, and walking may be difficult.

Recovery typically takes 4 to 6 weeks.

A grade 3 ankle sprain occurs when a ligament is completely torn or ruptured. Severe swelling, bruising, and instability are common, and weight bearing may be difficult or impossible.

Recovery can take several months.

A high ankle sprain is an injury to the strong ligaments that connect the two lower leg bones (the tibia and fibula) just above the ankle joint. These ligaments, called the syndesmosis, help stabilize the ankle during walking, running, and pivoting. 

High ankle sprains typically occur when the foot is planted and the leg twists outward. This motion is common in sports such as football, soccer, basketball, and skiing.  

Because this injury affects stabilizing ligaments above the ankle, it often causes more pain and takes longer to heal than a typical ankle sprain. In some cases, the twisting force can also place stress on the knee joint. 

Sprained ankle causes and risk factors

An ankle sprain occurs when the ligaments that support the ankle are stretched or torn. This often happens when the foot twists or “rolls,” forcing the ankle joint out of its normal position.

Ankle sprains are common in sports that involve running, jumping, or sudden changes in direction, especially on uneven or slippery surfaces. Activities such as basketball, soccer, trail running, and tennis place athletes at higher risk.

Several factors can increase the likelihood of an ankle sprain, including:

  • Weak ankle muscles or poor balance
  • Limited flexibility in the ankle joint
  • Improper or poorly fitting footwear
  • Returning to sports before a previous ankle injury has fully healed

Following an ankle sprain, the risk of repeated injury increases. While the ligaments heal and the ankle regains its strength and stability, the joint remains vulnerable to injury. Proper rehabilitation and a gradual return to activity can help reduce the chance of additional ankle sprains.

Diagnosing an ankle sprain

A doctor can diagnose an ankle sprain through a physical examination and imaging.

A physical exam may include:

  • Questions about how the injury occurred and the level of pain
  • Comparing the injured ankle to the uninjured ankle to assess swelling, range of motion, and bruising
  • Checking for areas of tenderness
  • Testing ankle stability and movement

If the injury appears severe, your doctor may order an X-ray to rule out a bone fracture. In some cases, an MRI may be used to evaluate the soft tissues surrounding the ankle.

How to treat a sprained ankle

Treatment for a sprained ankle focuses on protecting the ligaments and restoring strength, stability, and range of motion.

During the first 24 to 48 hours, doctors often recommend the RICE method:

  • Rest
  • Ice
  • Compression
  • Elevation

These steps help reduce swelling and protect the injured ligaments.

Early movement is often encouraged once pain allows. Gentle range-of-motion exercises may begin within the first day or two after injury to prevent stiffness and support recovery.

For more severe sprains, temporary immobilization with a brace or boot may be needed while walking. Physical therapy may also be recommended to restore strength, balance, and stability.

Sprained ankle recovery

Recovery from a sprain focuses on restoring ankle strength, flexibility, and balance.

Rehabilitation exercises typically include:

  • Range-of-motion exercises
  • Strength training
  • Balance and stability exercises

As athletes return to activity, they should initially avoid cutting, jumping, or uneven surfaces. Running on flat ground is often recommended during early return to sport.

For those returning to physical activity before the ankle completely heals, bracing or taping can provide additional stability. Learn more about how ankle taping reduces risk of injury.

In rare cases involving severe ligament damage, surgery may be recommended.

Recovery timelines by grade:

  • Grade 1: 1-3 weeks
  • Grade 2: 3-6 weeks
  • Grade 3 or high ankle sprain: several months

Preventing ankle sprains

Strength and preparation can help reduce the risk of ankle injury.

Sprain prevention strategies include:

  • Strengthening ankle and lower leg muscles
  • Improving stability and balance
  • Warming up properly before physical activity
  • Being cautious on uneven terrain
  • Wearing shoes appropriate for the sport or surface

FAQs

If you experience pain, swelling, bruising, or instability after an ankle injury, the ankle may be sprained. Some people also hear or feel a “pop” at the time of injury. A medical evaluation can confirm the diagnosis.

Sprains and fractures can cause similar symptoms. However, severe tenderness directly over the bone, numbness, or a visible deformity may suggest a fracture. An X-ray can help determine whether the injury is a sprain or a broken ankle.

Someone with a more mild sprain may still be able to walk without pain or instability, but many sprains make walking painful and difficult following injury. If you experience an ankle injury and have difficulty walking without pain, you should be evaluated by a medical professional as soon as possible.

A compression wrap is designed to support an ankle to prevent further injury during the day, so doctors advise leaving an ankle unwrapped while sleeping. 

Request an appointment

Request an appointment with a Mass General Brigham Sports Medicine specialist. The call center is available Monday–Friday, 8:00 am to 8:00 pm. Our dedicated team is committed to providing expert care for your sports injury. Please call us to determine the care that is best for you. 

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