The most common sports injury on earth — and the most under-rehabilitated. Treat it right the first time, and you avoid the sprain that keeps coming back.
An ankle sprain stretches or tears the ligaments stabilising the joint — most commonly the outer (lateral) ligaments after the foot rolls inward. Sprains are graded 1 (stretch), 2 (partial tear) or 3 (complete tear).
The injury itself heals well; the problem is incomplete rehabilitation, which leaves up to 30% of people with a wobbly, repeatedly-spraining ankle.
Landing on an opponent's foot, stepping on uneven ground, sports with jumping and cutting, unsupportive footwear, and — the biggest single risk factor — a previous poorly-rehabilitated sprain.
Weak hip muscles and poor balance quietly set the stage.
Pain and swelling over the outer ankle, bruising appearing over 1–2 days, difficulty bearing weight, and a feeling of instability. Severe sprains may 'pop'.
Suspect more than a sprain — get an X-ray — if you cannot take four steps, or there's tenderness directly on the bony prominences (malleoli), the base of the fifth metatarsal or the midfoot (the Ottawa rules your clinician applies).
Examination locates the injured ligaments and screens for associated injuries commonly missed: fractures, syndesmosis ('high ankle') sprains and peroneal tendon problems. X-rays only when indicated; MRI is reserved for high-grade injuries, suspicion of cartilage damage or pain that isn't following the expected recovery curve.
Almost all sprains — including complete grade 3 tears — are treated without surgery. Early phase (first 48–72 hours): protect, elevate, compress, ice for comfort, and avoid excessive anti-inflammatories which may slightly slow ligament healing. Then: early movement, weight-bearing as tolerated (with a brace for comfort), and progressive rehab.
Functional rehab beats rigid immobilisation — long casting weakens the ankle.
Reserved for specific situations: associated fractures, syndesmosis injuries with instability, osteochondral (cartilage) lesions, and chronic instability that persists after 3+ months of quality rehabilitation — where ligament repair or reconstruction (Broström-type procedures) gives reliable results.
First-time simple sprains essentially never need surgery.
Grade 1: back to sport in 1–3 weeks. Grade 2: 3–6 weeks. Grade 3: 6–12 weeks. The non-negotiable middle step is rehabilitation: calf and peroneal strengthening, and above all balance/proprioception training — single-leg stands progressing to unstable surfaces and sport drills.
Return to sport when hopping and cutting are pain-free and balance matches the other side; taping or a lace-up brace during sport for the first few months reduces re-injury.
Balance training twice a week, strong calves and hips, ankle braces or taping during high-risk sport if you've sprained before, decent footwear, and never skipping the last phase of rehab — the boring exercises are the ones that prevent the next sprain.
If you can't bear weight for four steps, or have tenderness directly on the ankle bones or the outer midfoot, you need an X-ray. When in doubt, get it checked — a missed fracture costs far more time than an X-ray.
Ice in the first 2–3 days for comfort and swelling; after the acute phase, either is fine — use what feels good. Neither speeds healing much; movement and progressive loading do.
No — recurrent giving-way suggests chronic instability from incomplete rehab or ligament insufficiency. A dedicated strengthening and balance program fixes most; persistent cases respond well to ligament repair surgery.
Short courses are reasonable for significant pain, but routine high-dose NSAIDs in the first days may slightly blunt ligament healing. Paracetamol, ice and elevation are sensible first choices.
Once you can walk briskly pain-free, hop on the injured leg comfortably, and balance on it as well as the other side — typically 2–4 weeks for mild sprains. Build up gradually on even ground first.
Written from current orthopaedic guidelines and peer-reviewed literature, and reviewed by the OssifiDE surgical team. Last reviewed: July 2026. This guide is educational and does not replace a consultation — your treatment should always be individualised by your doctor. Download the printable PDF leaflet to share with family or bring to appointments.
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