Most people think an ankle sprain is a minor injury that heals on its own. The reality? Many people never fully regain ankle stability, making them much more likely to sprain the same ankle again and again.
Why some ankle sprains may never fully heal
Ankle sprains happen when you roll, twist or turn your ankle in an awkward way. This can stretch or tear one or multiple ligaments that connect the bones around your ankle and provide stability.
Sprains are graded based on the severity of damage done to the ligaments surrounding the ankle:
- Grade 1 (mild): small amount of swelling; the ligament has tiny, microscopic tears and is stretched
- Grade 2 (moderate): medium amount of swelling; the ligament has a partial, incomplete tear and is stretched
- Grade 3 (severe): large amount of swelling; the ligament is ruptured and torn in half
The ligaments in your ankle contain nerve endings that affect your body’s awareness of your ankle position (proprioception). This means that healing isn’t enough, you have to retrain control. You need to be able to feel where your ankle and foot are in space without having to look at them. This will prevent future ankle rolls and twisting.
Why repeat ankle sprains happen
Anything that stretches your ligaments too far can sprain them, which typically can occur during slips, falls, or landing wrong after a jump. Ankle sprains are also among the most common sports injuries, especially in sports where you change directions quickly or pivot on your feet.
A sprained ankle can cause various symptoms depending on how serious the injury is. They may include:
- Pain, especially when putting weight on your ankle
- Tenderness to touch
- Swelling
- Stiffness
- Bruising
- Decreased range of motion
Many people often stop rehabbing these injuries once the pain and other symptoms go away. This can significantly increase risk for reinjury as pain often disappears before your body can fully recover its strength, balance, and stability.
When should you have an ankle evaluated?
You should see a doctor if you cannot put weight on your foot without pain, you are limping, you have moderate swelling or any bruising, your mobility/range of motion is decreased, or you are unable to participate in your specific sport or activities.
Treatment usually consists of rest and immobilization in a walking boot or ankle brace to promote healing. Then, once weight bearing is tolerable, rehabilitation can be started aggressively to regain strength, function, and balance. Pain medications can be used as needed to perform daily activities. Injections are not commonly needed.
How you can tell your body is recovered
Recovery time from a sprained ankle depends on the grade and severity of your injury.
- Mild: usually around 2-4 weeks
- Moderate: can take between 4-12 weeks
- Severe: can take 12+ weeks, on average, to recover
You have to be able to walk normally without pain before you can start to run, jump, and participate in sports. Your range of motion should return to normal along with the swelling dissipating. You should be able to walk on your toes and stand only on your injured ankle side with ease.
Common misconception
A sprained ankle is not the same as a “broken ankle” (ankle fracture). Fractures are severe injuries to bones whereas sprains are injuries to ligaments, which connect bone to bone and provide stability.
Fractures usually show up on x-rays, but ligaments are not visible on x-rays. Ligaments can be seen on ultrasound and MRI.
A fracture will cause more localized tenderness and pain to the bone, and a ligament sprain is generally more painful around the bones in the areas of soft tissues (which include ligaments).
Both injuries can cause a crack or pop feeling or sound.