[Smart Doctor] Runners Take Note! Essential Guide to Sprained Ankles | Ankle Sprain

Q. What is an ankle sprain?

A. An ankle sprain occurs when you twist, roll, or turn your ankle in an awkward way, causing damage to the ligaments that provide joint stability.

Ligaments in the ankle are broadly categorized into medial (inner) and lateral (outer) ligaments. Among them, lateral ankle ligament injuries are far more common.

The lateral ankle ligament complex mainly consists of three parts: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL).

The severity of the injury can be graded depending on the location and number of injured ligaments, as well as the extent of the damage.

When classified by the degree of ligament damage, ankle sprains are graded as Grade 1, Grade 2, or Grade 3.

A Grade 1 sprain involves microscopic tears or simple stretching of the ligament. Grade 2 involves a partial tear, and Grade 3 signifies a complete tear.

A Grade 3 tear, in particular, results in severe pain and swelling, often making it impossible to bear weight or walk.

Because its symptoms closely mimic an ankle fracture, it is vital to visit a clinic, get an X-ray, and receive an accurate examination.

Q. Do I always need surgery for an ankle sprain?

A. The vast majority of ankle ligament injuries heal completely without surgery.

In fact, undergoing surgery during the acute phase when the ankle is swollen can lead to serious wound-healing complications,

and post-operative pain may lead to joint stiffness.

Therefore, surgery is required only in very limited circumstances!

Surgical intervention is typically considered only when multiple ligaments are completely torn, resulting in severe joint instability,

or in high-level elite athletes who perform high-impact physical activities and require a rapid return to competition.

Q. In what cases is surgery actually considered?

A. Surgery may be considered if a patient develops "chronic ankle instability," where the ankle repeatedly rolls or gives way despite undergoing appropriate care and rehabilitation exercises.

However, chronic ankle instability affects only a minority of sprain patients,

which means the vast majority of ankle sprains can be fully resolved with non-surgical treatments.

Q. How are ankle sprains treated?

A. Initial management typically follows the PRICE protocol.

Protect the injured area (Protection), get adequate rest (Rest), and apply ice packs (Ice) to decrease pain and swelling.

Applying a compression bandage (Compression) to the injured site also aids recovery.

Finally, elevate the leg above the level of your heart (Elevation).

For a Grade 1 sprain, a cast is usually not required,

and wearing an ankle brace for about the first week is sufficient.

For Grade 2 and Grade 3 sprains, a cast or splint is worn for around two weeks, followed by an ankle brace depending on the degree of damage.

Afterward, you should learn recovery and rehabilitation exercises.

The two key components to focus on are ankle muscle strengthening and balance training, medically known as proprioceptive training.

Q. What exercises can I perform at home?

A. First is the single-leg heel raise hold.

Start by holding the position for 1 or 2 seconds, gradually working up to holding it for 15 seconds.

You can also purchase an affordable balance board online or at a store.

Standing on it and maintaining balance without falling is another great way to train proprioception.

Ligaments are not the only structures providing ankle stability.

The muscles and tendons surrounding the ankle work together to support it,

with the peroneal muscles located on the lateral side of the ankle playing a crucial role.

Here is a simple way to strengthen your peroneal muscles at home.

Using a resistance band that can be easily found in stores,

performing ankle eversion exercises—turning the foot outward against resistance—is an effective way to prevent recurring sprains.

While you should not return to strenuous exercise too soon after an ankle sprain, resting for too long is equally counterproductive.

Following a 1 to 2-week period of rest and protection, actively engaging in rehabilitation exercises is the best way to safeguard your ankle health.

Because an ankle sprain requires early and accurate diagnosis and care, we encourage you to visit a clinic and receive proper medical evaluation.

Frequently Asked Questions

Do I always need surgery for an ankle sprain?

No, most ankle sprains heal without surgery. Operating during the acute phase carries risks of joint stiffness and wound complications, making conservative care the first choice. Surgery is reserved for select cases, such as complete tears in multiple ligaments causing severe joint instability or persistent chronic ankle instability despite rehabilitation.

What is the initial first aid for a twisted ankle?

Immediate care should follow the PRICE protocol: Protect the injured area with a brace or cast (Protection), rest sufficiently (Rest), apply ice packs to reduce swelling (Ice), and apply compression (Compression). Elevating the injured leg above the heart level (Elevation) is also crucial.

What does a Grade 3 ankle sprain mean?

A Grade 3 sprain indicates a complete tear of the ligament, accompanied by severe pain and swelling that often impairs walking. Because the symptoms are similar to fractures, obtaining an X-ray at a clinic for an accurate differential diagnosis is critical. Treatment typically involves wearing a cast for about two weeks, followed by a brace based on recovery progress.

What rehabilitation exercises can I do at home after an ankle injury?

Single-leg heel raise holds and resistance band eversion exercises are very effective. Aim to hold the single-leg balance for up to 15 seconds, and use a balance board to enhance proprioception. Outward eversion exercises with an elastic resistance band also strengthen the peroneal muscles, which stabilize the outer ankle.