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The challenges of managing ankle sprains – why they aren’t so simple

‘Sprained ankle problems’ aren’t always straightforward. Six weeks after a sprain, over 73% of people still have problems, and 18 months half of people are still struggling. Would you believe that just over a third of people still have problems SEVEN years later?  I know that this problem seems particularly prevalent in my community – I draw people from Shepherds Bush, Hammersmith, Notting Hill and Holland Park – a very sporty bunch – and I have seen many niggling ankles.

This overwhelmingly frequent problem of an endless niggling ankle might be prevented if you get seen early.  If it’s more than a simple ankle sprain, a proper early referral is important to prevent long term disability.

What can go wrong?


Very often, a bad sprain can also be accompanied by fractures of some of the small bones of the toes, the mid foot and ankle joint, or a disruption of the connective tissue between the two bones of the leg.  These injuries can cause disability and significant pain.  Early screening using orthopedic testing and diagnosis can help determine if one of these injuries are present.

Ligament Damage

There are three main ligaments that can be hurt even in ‘normal’ sprains. One is in the front of the ankle, and this is the most common ligament that is hurt. If a ‘normal’ sprain isn’t getting better after 6 weeks, an MRI could determine if the other two are damaged.  Unfortunately if they are severely damaged then a surgical intervention may be required to stabilise the ankle.

We often focus on the outside of the ankle in a lateral ankle sprain – but this kind of ‘going over’ on the ankle can also compress and damage the ligaments on the inside of the foot as well.

Tendon Injury

Sometimes the tendons that move the sole of the foot side to side can be strained or hurt, or the tissues that ‘hold down’ the tendons close to the bone can be torn.  If the tendons are swollen but not damaged, gentle rehab and sometimes injections can help.  If the tendons are torn, or if you can ‘snap’ them over the outside of the bone in front of them, then the best long term outcome will come from surgery and post-surgery rehabilitation.

Talar Dome injuries

Sometimes a person with an ankle injury will come through rehab reasonably well and when they start to do more high impact sport and find they have new ankle problems.  They may have tenderness or swelling in the front of the joint.  They may not be able to stand on their toes.  The smooth top of a bone called the Talus is what lets us point our toes and stand on our heels – it is like the ‘ball’ of a ball and socket.  If the ball is damaged, the whole joint suffers.  A chronic injury here can cause arthritis, so it’s important to get a ‘chronic ankle problem’ thoroughly checked out.

Midfoot Injuries

Occasionally, when someone has an inversion or eversion injury with some kind of force (falling on a pointed foot), a midfoot injury can happen where the small bones of the foot can become dislocated.  A person might not be able to stand on their heel with this kind of injury.  Bruising and pain on the top and bottom of the foot can sometimes indicate a dislocation or fracture of the bones of the midfoot.

What do we do to help?

When someone ‘goes over’ and has an ankle sprain, compression and rest are very important to support the healing process.  Ice can help the person be more comfortable, but it only useful for 5-10 mins every couple of hours during the first two days.  Ice (and NSAIDS) can hinder the helpful and important inflammatory process if overused for longer periods of time.

If the ankle has been assessed and no serious longer term injury seems to be present, very gentle movement/mobilisation is helpful.  This can be passive and active, and bodyweight can be used gently as soon as possible.

Later, gentle proprioceptive balance training with gently increased load will be incorporated into the ankle rehabilitation for your sprained ankle. Once someone can do a single leg hop comfortably, sports like gentle running on flat ground can be resumed slowly and carefully. Once this is comfortable, more stopping/turning type training can be started with a gradual building of time and intensity until full recovery has been made.   It’s important to get the injured ankle reassessed regularly throughout the rehabilitation to deal with any setbacks or adaptation issues that have developed.

If you’d like to book in for an assessment, you can do so directly into the diary.


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