Ankle Sprain & Instability

The ankle joint is where the bones of the leg and foot meet. The leg is made up of the large Tibia and the smaller Fibula, which rest on the Talus bone in the foot. Beneath the Talus is the Calcaneus, or heel bone, which bears 85-100% of our body weight.

Ligaments, strong bands of tissue, connect the bones of the leg and foot. The Lateral Collateral Ligament (LCL), located on the outer side of the ankle, is highly susceptible to sprains. It plays a crucial role in maintaining balance and stability during movement. The LCL is composed of three sections: the Anterior Talofibular Ligament (ATFL), the weakest and most prone to injury; the Calcaneofibular Ligament (CFL); and the Posterior Talofibular Ligament (PTFL), which is the strongest and least likely to be injured.

Ankles are vulnerable to instability when walking on uneven surfaces, stepping at awkward angles, playing sports, or wearing improper footwear like high heels. Even the fittest individuals can experience a sudden loss of balance. When the foot is placed at an abnormal angle, the body weight puts excessive pressure on the ligaments, causing them to stretch. If the ligaments are stretched too far, they can tear or detach from the bone.

Symptoms of an ankle sprain often include difficulty walking or bearing weight, and in some cases, a "popping" sound may be heard at the time of injury. Pain is usually immediate, followed by swelling, stiffness, and bruising. These symptoms can develop within a few hours after the injury.

A doctor will diagnose a sprained ankle through a physical exam and by asking about the cause of the injury. The doctor will move the ankle in different directions to identify which ligaments were affected. X-rays may be used to rule out fractures, and in severe cases, an MRI may be recommended to assess the extent of the ligament damage. Sprains are classified based on severity: Grade 1 involves minor stretching, Grade 2 is a partial tear, and Grade 3 is a complete tear with significant joint instability.

Most ankle sprains heal with non-surgical treatments. It is crucial to seek medical evaluation to rule out fractures.

Treatment depends on the sprain’s severity. Grade 1 sprains are managed using the RICE method—Rest, Ice, Compression, and Elevation. Crutches may be used to avoid weight-bearing, and pain relief can be managed with medication. For Grade 2 sprains, a soft splint or air cast may be recommended alongside the RICE method, and an ankle brace can offer additional support as healing progresses. Grade 3 sprains often require a cast or cast-brace for 2-3 weeks, followed by rehabilitation to restore movement, strength, and coordination. Recovery time varies, with Grade 1 sprains healing in about six weeks, while more severe sprains may take several months.

Surgery is rarely needed for ankle sprains but may be considered when non-surgical treatments fail. Surgical options include ligament tightening or tendon grafts to repair severely damaged ligaments. Arthroscopic surgery may be performed to remove scar tissue or damaged cartilage in cases of chronic pain. Recovery from surgery typically involves wearing a cast for up to two months, followed by rehabilitation to restore strength and mobility.

Recovery time depends on the severity of the sprain and the treatment used. Grade 1 sprains may heal in six weeks with minimal impact on mobility. Grade 2 sprains require a few months for recovery, while Grade 3 sprains may take several months. Rehabilitation is key to restoring strength and range of motion. Surgical recovery involves physical therapy and usually takes six months.