A lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries, particularly in athletes and active individuals. It occurs when the foot rolls inward (inversion), placing excessive stress on the lateral structures of the ankle. LAS can happen during daily activities such as walking on uneven ground or stepping off a curb, but also frequently during sports involving jumping, pivoting, or sudden directional changes.
Structures Involved in a Lateral Ankle Sprain
Most lateral ankle sprains involve injury to the lateral ligament complex, which includes:
· Anterior talofibular ligament (ATFL) – most commonly injured
· Calcaneofibular ligament (CFL)
· Posterior talofibular ligament (PTFL)
These ligaments can be stretched or torn, depending on the severity of the injury. In some cases, muscle spasms or even avulsion fractures (where a tendon or ligament pulls off a small piece of bone) may occur due to the body’s reflexive attempt to stabilize the ankle through forceful contraction of the peroneal muscles.
Additionally, overstretching of the peroneal nerve and intrinsic foot ligaments may contribute to prolonged discomfort or altered sensation.
Symptoms of Lateral Ankle Sprains
Symptoms can vary in intensity depending on the grade of sprain:
· Grade I (mild): minor ligament stretching, mild tenderness, minimal swelling
· Grade II (moderate): partial ligament tear, moderate swelling and bruising, difficulty weight-bearing
· Grade III (severe): complete ligament tear, significant swelling and bruising, instability
Common signs and symptoms include:
· Pain and tenderness on the outside of the ankle
· Swelling and bruising (ecchymosis)
· Difficulty walking or weight-bearing
· A feeling of instability
· In some cases, numbness or tingling due to nerve irritation
When to See a Doctor
While many lateral ankle sprains can be effectively managed with conservative care, you should see a doctor immediately if you experience any of the following:
· Inability to bear weight on the affected foot immediately after the injury or 48 hours later
· Significant swelling or bruising within minutes of injury
· Visible deformity of the ankle or foot
· Numbness, tingling, or loss of sensation in the foot
· A “popping” sound at the time of injury, followed by severe pain
· History of repeated ankle sprains or instability
· Signs of infection (redness, warmth, fever) after the injury
A doctor may recommend X-rays or other imaging to rule out fractures or more serious ligament damage. Timely diagnosis helps ensure the proper course of treatment and avoids chronic issues.
Evidence-Based Recovery & Rehabilitation
Initial Phase (0–3 days)
· Relative rest is advised to minimize further injury, but complete immobilization is often counterproductive unless there’s a fracture.
· Ice, compression, and elevation may help with swelling in the first 48–72 hours.
· Early protected movement and weight-bearing as tolerated has been shown to promote healing and reduce long-term stiffness.
Subacute Phase (4 days – 2 weeks)
· Begin gentle mobility exercises, such as ankle circles and alphabet exercises.
· Gradual introduction of strengthening and balance work, especially targeting the peroneal muscles.
· Supervised manual therapy and neuromuscular training enhance outcomes.
Functional Phase (2–6+ weeks)
· Progress to sport-specific drills, plyometrics, and dynamic balance training.
· Address any biomechanical issues (e.g., poor foot alignment or hip weakness) to reduce risk of recurrence.
A graded, individualized physiotherapy plan improves return-to-activity timelines and reduces the likelihood of chronic ankle instability.
What to Avoid During Recovery
· Over-reliance on passive treatments such as ultrasound or heat
· Avoiding activity altogether for prolonged periods can lead to muscle weakness and joint stiffness
· Returning to full activity too soon, especially if instability or poor proprioception remains
· Ignoring persistent symptoms; untreated sprains may evolve into chronic ankle instability, which affects up to 40% of patients after their first LAS
When to See a Physiotherapist
Early intervention from a physiotherapist can speed up recovery and reduce complications. A comprehensive rehab program will focus on:
· Restoring range of motion
· Rebuilding strength and endurance
· Re-establishing balance and proprioception
· Preventing re-injury through education and progressive return-to-sport planning
Conclusion
Lateral ankle sprains are common but treatable injuries. With appropriate early management and a well-designed physiotherapy program, most individuals make a full recovery. However, recognizing when to consult a doctor or physiotherapist is critical in preventing long-term complications like chronic instability or re-injury.