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Ankle Sprains: Recognition and Treatment

Primary care physican can treat most instead of ER

Ankle sprains are the most common injury in high school sports, with high rates of recurrent injury and loss of participation from sport (1,2) 

What is a sprain?

A sprain is a stretch and/or tear of a ligament, the fibrous band of tissue joining the end of one bone with another that stabilizes and supports the body's joints.

Because the outer ankle is more stable than the inner ankle, the foot is likely to turn inward (ankle inversion) from a fall, tackle, or jump. This stretches or tears ligaments; the result is an ankle sprain. The lateral ligament on the outer ankle is most prone to injury. As a result, virtually all ankle sprains are "inversion" sprains.


Symptoms and treatment of ankle sprains

As with burns, there are three "degrees" of sprains: mild (first-degree), moderate (second degree) and severe (third-degree). While the intensity varies, pain, bruising, and swelling (inflammation) are common to all three categories. 


First Degree (Mild)

Second Degree (Moderate)

Third Degree (Severe)


Minor stretching of ligaments

Partial tear of ligaments

Complete tear of ligaments, or ligaments separate from bone


Not necessary unless suspect a fracture

Note: Studies show that x-rays are ordered for 80% to 90% of patients who go to the ER after a foot or ankle injury, yet only 15% actually have fractures. (2)

Sometimes, depending on exam. 

Sometimes, depending on exam

Emergency room or doctor's office visit

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day

Call doctor but, unless instructed by doctor to go to ER, wait to see doctor on next business day


Minimal; may not be swelling for several hours



Ankle Instability?


Yes (mild)

Yes (unable to bear any weight)

Painful to stand and walk?



Yes. Excruciating pain at moment of injury


PRICE, non-steroidal anti-inflammatory drugs (NSAIDS), functional rehabilitation (ankle stabilization via elastic bandage, braing, taping or external support or combination), progressive weight bearing and exercise.

PRICE, NSAIDS, functional rehabilitation plus crutches (rent at medical supply store)  until can bear weight well (recovery time varies from a few days to a week);

PRICE, NSAIDS, functional rehabilitation; cast and crutches, although no consensus on the best type and duration of immobilization (2); surgery may be necessary

From 2 days up to a week

Usually 2 to 3 weeks (after physical therapy), but possibly as long as 6 weeks

Recovery after intensive physical therapy may take 6 to 8 weeks

Proper treatment and management essential 

Lest you think that acute ankle sprains aren't serious, or don't require medical treatment, think again. Studies show that up to 70% of those who suffer ankle sprains will suffer from repetitive sprains, and go on to suffer chronic ankle instability (CAI) (up to 74%, according to one study[3]).

Research shows that long-term patients who develop CAI often going on to develop post-traumatic ankle osteoarthritis,[4] which a 2015 study[5] by researchers at the University of North Carolina - Charlotte suggests may be a direct consequence of the approximately 50% of patients who suffer an ankle sprain but do not seek any medical treatment or evaulation. 

That study, which found a single severe ankle sprain significantly decreased physical activity levels across the lifespan in mice, and which followed closely on the heels of a study by the same researchers[6] finding that college students with CAI took on average more than 2,000 fewer steps per day than healthy controls. led the authors to warn that, "[a]though [an] initial ankle sprain may be thought of as a relatively minor or insignificant injury, if not treated appropriately, or with lack of guidance with rehabilitation and exercise prescription, physical activity levels across a lifespan may decrease," which is a "significant public health concern given the cost associated with treating chronic disease development as well as the further loss of function the patient may experience." 


1. Swenson D, Collins C, Fields S, Comstock D. Epidemiology of US High School Sports-Related Ligamentous Ankle Injuries, 2005/06 - 20010/11. Clin J Sport Med 2013;23(3):190-196.

2. Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins TJ, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Tr 2013;48(4):528-545.

3. McKay GD. Ankle injuries in basketball: injury rate and risk factors. Br. J. Sports Med. 2001;35:103-108.

4. Hinterman B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability.  Am J Sports Med 2002;30(3):402-409. 

5. Hubbard-Turner T, Wikstrom EA, Gudarian S, Turner MJ. An Acute Lateral Ankle Sprain Significantly Decreases Physical Activity across the Lifespan.  J Sports Sci Med. 2015;14:556-561 (published online ahead of print August 11, 2015) 

6. Hubbard-Turner T, Turner MJ. Physical Activity Levels in College Students With Chronic Ankle Instability.  J Athl Tr. 2015;50(7):742-747. 

Updated September 17, 2015

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