Understanding Ankle Sprains: Types, Severity, and Treatment
Ankle sprains are among the most common injuries, affecting both athletes and non-athletes. The most frequent type is an inversion sprain, also known as a lateral ankle sprain. These occur when someone steps down and lacks stability in the weight-bearing leg, causing the leg to roll outward while the foot turns inward. This motion places excessive stress on the lateral ligaments, which support the outside of the ankle.
Severity can range from mild overstretching to complete ligament rupture.
Ankle Sprain Classification: Grades I–III
Grade I Sprain
Description:
Microscopic ligament injury without full stretching.
Symptoms:
Mild swelling
Slight tenderness
Minimal functional limitations
Typical Recovery: ~2 weeks
Grade II Sprain
Description:
Partial stretching of the ligament (macroscopic), but no full tear.
Symptoms:
Moderate swelling
Bruising
Pain
Noticeable loss of ankle stability, range of motion, and efficient walking mechanics
Grade III Sprain
Description:
Complete rupture of the ligament.
Symptoms:
Significant swelling
Extensive bruising
Severe tenderness and pain
Major functional limitations, especially with weight-bearing and walking
Additional Injuries Associated With Lateral Ankle Sprains
A lateral ankle sprain doesn’t only affect ligaments. The same mechanism of injury may also result in trauma to:
Muscles
Bones
Joints of the lower leg and foot
Severe ankle sprains can lead to:
Ankle fractures
Muscle strains or tears
Depending on injury severity, treatment may include:
Crutches
Immobilization
Surgery
This is why it’s important to see a healthcare provider early—they can determine the full extent of the injury and guide the appropriate plan of care.
Treatment and Rehabilitation
Initial treatment varies based on severity, but physical therapy is a key component for most ankle sprains. The goal is to restore movement, strength, stability, and confidence.
A complete physical therapy plan should focus on:
Decreasing pain and swelling
Improving ankle range of motion
Restoring gait mechanics
Increasing load tolerance
Strengthening the muscles of the foot, ankle, and lower leg
Rehab should progress gradually and be tailored to the demands of daily activity, work, or sport.
Chronic Ankle Instability: A Preventable Problem
While most ankle sprains recover well, some individuals develop chronic ankle instability—characterized by repeated sprains, persistent weakness, or a feeling that the ankle is “giving out.”
Some studies estimate that up to 20% of patients experience chronic ankle instability after an ankle sprain.
This makes early, progressive physical therapy crucial. Proper rehab not only treats the current injury but also reduces the risk of future sprains and long-term instability.
Take-Home Message
Pain is not the best metric for judging your ankle rehab progress.
You need adequate:
Strength
Range of motion
Neuromuscular control
to return to full performance and decrease the likelihood of reinjury.
Consistent, well-structured rehabilitation is the key to long-term ankle health.
References:
Martin, R.L., Davenport, T.E., Paulseth, S., Wukich, D.K., Godges, J.J. Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains. Journal of Orthopedic and Sports Physical Therapy. J Orthop Sports Phys Ther 2013;43(9):A1-A40. doi:10.2519/jospt.2013.0305
Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016;6(4):103–108. doi:10.4103/2231-0770.191446
