Ankle sprains are more common in athletes participating in sports with side-to-side movement than in those with straight-ahead motion. Court sports such as basketball, tennis, and racquetball all spawn their fair share of ankle sprains. Running on level ground does not often result in an ankle sprain, but cross-country running, trail running, stepping in a pothole, or missing the curb can all potentially lead to an ankle sprain. The most frequent ankle sprain is an inversion ankle sprain, in which your arch turns inwards. This can injure the outer (lateral) structures of the ankle.

The most common ankle injury resulting from an inversion is a partial tear of the anterior talofibular ligament (ATFL). This ligament can be partially torn or may also tear completely. The next most frequently injured ligament is the calcaneofibular ligament. The least injured is the posterior talofibular ligament. On occasion, the fibula itself may be fractured or the talar dome injured. The other structures on the lateral side of the ankle should always be carefully examined to make sure they are not injured.

The grading of ankle sprains is done using a three-point scale. Grade 1 is a mild stretch of ligament(s), Grade 3 is a complete tear of ligament(s), and Grade 2 is everything in between.

Treatment for Ankle Sprains

It is impossible to guess how badly injured you are. If you have doubts or if your ankle swells very rapidly, you should head for an emergency room. Immediate treatment should consist of RICE: Rest, Ice, Compression (gentle), and Elevation of the limb. The ice (or a cold pack) should be applied for about 15 minutes at a time and then removed for at least the same amount of time. A bag of frozen corn or peas also works well. If your ankle does not respond quickly to this treatment, it is probably best to visit your sports physician for an evaluation and treatment.

For Grade 2 sprains, an air cast is sometimes recommended to hold the ankle still to prevent further tearing or strain as it heals. A removable walking cast is used for the more serious sprains to provide stability and security while allowing you to bear weight without pain.

Starting to Exercise the Injury

The first exercise to try once your ankle starts to feel better is dorsiflexion–plantar flexion, or just plain moving the foot up and down (called an ankle pump). Progress to performing such things as moving your foot in small circles and painting the alphabet with your toes. Later still, you can use an exercise band and perform other exercises to strengthen the muscles that control your ankle.

Don't force your ankle to move in pain too soon, and avoid weight bearing or walking in pain early in the course of an ankle sprain. You might need to walk with a cane or crutch. There is no reason to start testing your ankle until it has had time to heal. “Slow and easy” gains more than rushing into painful exercises.

One way to see if you are ready to resume your full exercise regimen is to try walking down stairs, hopping, or jumping rope. Before attempting to run again, you must be able to walk for at least 20 minutes without limping, pain, or limitation. For Grade 2 and Grade 3 ankle sprains, physical therapy treatment may be necessary to restore your full range of motion, strength, proprioception, and to help you to safely return to running.