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Ankle Sprain

An injury to one or more ligaments in the ankle when the foot rolls, turns or twists in an awkward direction, resulting in stretching or tearing of the ligaments.


  • Ligament injury most commonly occurs in sports requiring change of direction, landing and uneven surfaces.

  • Ligament injury can also result from a contact injury, in which an object forces the foot into an end range position

  • Damage most commonly occurs to the lateral ligaments (outside of the ankle), when the ankle rolls out

  • The most common risk factor for an ankle sprain is previous history of ankle sprain

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Signs & Symptoms

  • Pain in the lateral or medial side of the ankle

  • Bruising and swelling of the ankle and foot

  • Tenderness to touch

  • Feelings of instability

  • Difficulty weightbearing through affected leg

Differential Diagnosis

  • Fracture

  • Ankle Syndesmosis Injury

  • Ankle Impingement

  • Peroneal Tendinopathy

PROmotion Assessment and Outcomes Measures

  • Subjective examination addressing mechanism of injury, aggravating positions and 24hr pain

  • Assessment of ability to weight bear, ankle range of motion, ligament tests and palpation of the bones and ligaments to rule out need for XR or further imaging

  • Assessment of balance, lower limb strength and control

  • Assessment of sporting footwear

How to Manage

  • Referral for XR if fracture is suspected.

  • Period of relative rest from sport +/- immobilisation in a moon boot/crutches/taping dependent on extent of injury

  • If applicable manual therapy to improve ankle range of motion, reduce pain and increase function

  • Graduated home exercise program consisting of range of motion, strengthening and balance exercises for the ankle and lower limb.

  • Advice regarding return to activity and load management as injury progresses.

  • Management may also include referral to a sports doctor for review if any further medical intervention such as imaging, differential diagnosis and assistance with management plan.


  1. Doherty C., Delahunt E., Caulfield B., Hertel J., Ryan J., Bleakley C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine; 44: 123-140.

  2. McGovern R.P., Martin R.L. (2016). Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine; 7: 33-42.

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