Ankle Sprain

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Learn more about “Ankle Sprain”


Ankle sprains happen to people of all ages. They occur when you ‘roll your ankle’, which over-stretches the ligaments (the fibrous bands that hold the ankle together).  Inversion-type, lateral ligament injuries represent approximately 85% of all ankle sprains. The incidence of ankle sprain is highest in sports populations. Poor rehabilitation after an initial sprain also increases the chances of this injury recurrence.

Ankle sprain is one of the most common sports-related injuries and can lead to recurrences and chronic ankle instability (CAI). Moreover, in the acute phase, ankle sprain patients experience mostly pain, limited ankle mobility, and reduced ankle muscle strength. CAI patients have a history of their ankle “giving way” and/or “feeling unstable,” after at least one significant ankle sprain. They continue to suffer from pain and impaired performance during functional tasks.

In addition, when a ligament tears or is overstretched its previous elasticity and resilience rarely returns. Some researchers have then described situations where return to play is allowed too early, compromising sufficient ligamentous repair. Reports have also proposed that the greater the level of plantar flexion the higher the likelihood of sprain. Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one. A less common mechanism of injury involves forceful eversion movement at the ankle injuring the strong deltoid ligament.

Risk Factors

Researchers have identified numerous factors that may cause injury, including the age of the player, injury conditions (during practice or game), factors in body size, history of previous injury, mechanism of injury (contact or noncontact), use of external ankle support, and player position. These issues, either individually or in different combinations, may contribute to the occurrence of injury.

Additionally, two factors that may affect the risk of ankle sprain are use of external ankle support and history of ankle sprain. Investigators have then shown that external ankle support may prevent injury and that a previous strain or sprain on the same side of the ankle is a strong predictor for reinjury. Also, athletes who have a history of ankle sprain and who use a brace or tape appear to have a lower incidence of ankle sprain, which indicates that the interaction between these 2 factors affects the occurrence of injury.


Symptoms include:

  • feeling that the ankle gave way at the time of injury;
  • a pop or crack;
  • pain on weight bearing;
  • swelling; and
  • bruising.

Moreover, ankle sprain is one of the usual injuries in basketball players. The relevant causes include frequent jumps, landings, cutting maneuvers, and also contact with other players. Investigators also have reported that basketball players have a high rate of recurrence of ankle sprain. To our knowledge, many authors have examined ankle sprains in amateur basketball players. However, few investigators have examined professional players, and their studies mainly have focused on American basketball players. In theory, professional players demonstrate higher fitness and technique levels than do amateurs. High fitness levels combined with more aggressive play may result in more contacts between players and more movements and, therefore, in a higher risk of injury. Because ankle sprain is a common basketball injury, examination of the risk factors for injury in professional players is worthwhile.

Classification of Grading Systems

There are numerous grading systems used for the classification of ligament sprains, each having their strengths and weaknesses. Different therapists may employ different systems so effective continuity of care, the patient should see the same therapist each time. Authors do not always disclose which system they used, reducing rigour and quality of some research.

The traditional grading system for ligament injuries focuses on a single ligament

  • Grade I represents a microscopic injury without stretching of the ligament on a macroscopic level.
  • Grade II has macroscopic stretching, but the ligament remains intact.
  • Grade III is a complete rupture of the ligament.

As there are ankle multiple ligaments across the joint it may not be always straight forward to use a grading system that is designed for describing the state of a single ligament unless it is certain that only a single ligament is injured. Some authors have therefore resorted to grading lateral ankle ligament sprains by the number of ligaments injured. It is, however, hard to be certain on the number of ligaments torn unless there is clear, high quality radiographic or surgical evidence.

A third system which can be adopted is a 3 graded classification based on the severity of sprain injury.

  • Grade I Mild – Little swelling and tenderness with little impact on function
  • Grade II Moderate – Moderate swelling, pain and impact on function. Reduced proprioception, ROM and instability
  • Grade III Severe – Complete rupture, large swelling, high tenderness loss of function as well as marked instability

This scale is largely subjective due to individual therapist interpretation. However, the same can be said for the other classifications unless clear radiographic evidence is available or assessed and treated by surgical intervention.


There are simple measures you can take to reduce the risk of an ankle sprain.

  • Warm up before exercise.
  • Wear supportive shoes.
  • Take care when exercising on uneven or slippery ground.
  • Tape the ankle as directed by your physiotherapist.
  • Cool down with slow stretches after exercise

At the Chelsea Clinic chiropodists and podiatrist, we only recommend measures we have mentioned above for the present time. We are here to help you and to treat any painful nails.  Let us make you pain-free as soon as possible.

For more information call us ☎️ at + 44 (0) 20 7 101 4000 or email us 📩 at  We look forward to speaking with you.



Check our latest blog about Turf Toe here

Related Pages:

Check our blog about Ankle Injuries here

Read our blog about High Ankle Sprain here

Check our blog about Ankle Eversion Injury here



Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wickstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. American journal of sports medicine. 2016.The American Journal of Sports Medicine Vol 45, Issue 1, pp. 201 – 209

Ilona M. Punt, Lara Allet 21 December 2016. Handbook of Human Motion pp 1-16| Functional Effects of Ankle Sprain

Starkey C. Injuries and illnesses in the National Basketball Association: a 10-year perspective. J Athl Train. 2000;35:161–167.

Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas high school basketball: a prospective study among male and female athletes. Am J Sports Med. 1999;27:294–299.

Wright, I. C., Neptune, R. R., van den Bogert, A. J., & Nigg, B. M. (2000). The influence of foot positioning on ankle sprains. Journal of biomechanics33(5), 513-519.

Yeung, M. S., Chan, K. M., So, C. H., & Yuan, W. Y. (1994). An epidemiological survey on ankle sprain. British journal of sports medicine28(2), 112-116.

Deitch JR, Starkey C, Walters SL, Moseley JB. Injury risk in professional basketball players: a comparison of Women’s National Basketball Association and National Basketball Association athletes. Am J Sports Med. 2006;34:1077–1083.

Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: a literature review. J Athl Train. 2002;37:376–380.

Lynch S. Assessment of the Injured Ankle in the Athlete. J Athl Train 2002 37(4) 406-412

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Paola Ash at the Chelsea Clinic

At The Chelsea clinic we have a very specific skill set with regards the foot and ankle. Pleased to offer a bespoke service which is tailored to the individual. With over 20 years experience in the Fitness and Healthcare industry we are registered and qualified with the Health Care Professions Council, the College of Podiatry and the General Osteopathic Council.