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Ankle Ligament Injury

Sprained Ankle

Minute Read


Posted 1 year ago


Last updated: 03/12/2022


by James McCormack

Sprained Ankle Anatomy

The function of a ligament is to attach two bones together. There are 3 lateral ligaments on the outer side of the ankle. If they become stretched through the rolling of an ankle, they can become irritated and painful. This is the most common type of soft tissue injury to the ankle and is referred to as a sprained ankle. A Lateral Ligament Ankle Sprain can result in pain and swelling on the outside of the ankle. In the majority of cases, these injuries can be managed and resolved with appropriate home care but in some instances, they require the input of a medical professional.

The 3 most commonly affected ligaments from an ankle sprain are the Anterior Talo-Fibular Ligament (ATFL), Calcaneofibular Ligament (CFL) and the Posterior Talofibular Ligament (PTFL). The ATFL is positioned nearest the front of the ankle, the CFL is in the middle of the three and the PTFL is positioned towards the back of the ankle.

The function of the lateral ankle ligaments is to provide support and stability to the ankle while providing resistance against the inward rolling of the ankle.

In this article we will explore all there is to know about Lateral Ligament Ankle Sprains, how to treat them at home, and what care under a medical professional would entail.

Sprained Ankle Diagram

Sprained Ankle Causes

When a ligament is stretched from an ankle sprain, it may not return to the same length that it was previously. This can make the ankle more prone to repetitive ankle sprains that can result in microtrauma to the ankle over time.

  • Stepping off a curb
  • Walking on uneven surfaces
  • Changing direction at speed
  • Trauma, most commonly from a tackle when playing sport

Person spraining their ankle walking

Sprained Ankle Symptoms

There are 3 broad classifications of ankle sprains relevant to the severity of ligament tear. Learn the symptoms of each below.

Grade 1 Ankle Sprain

The ligament is overstretched, leading to pain in the outer ankle. It is not unusual to have no swelling for a grade 1 ankle sprain. These often happen innocuously such as walking on an uneven surface with no pain at the time of injury but delayed pain up to 24 hours after.


There may be mild yellow bruising but it is not uncommon to have no bruising at all. As the injury begins to heal there may be an itchy sensation on the site of injury.




Grade 2 Ankle Sprain

This involves a partial tear of the ligament. It is often the result of a sudden movement such as a fall, or slip when changing direction. It is associated with an immediate onset of pain and swelling within 24 hours of injury. A purple bruise may appear on the side of the ankle and this may seep down to cause bruising to the side of the foot due to gravity.


It can be painful to walk but not impossible with the worst pain when changing direction or inverting the foot while there is normally less pain when moving in a straight line. Pain can be worse at night after use during the day.

Grade 3 Ankle Sprain

This is a complete tear or rupture of a ligament. It is the result of a very sudden or sharp movement or fall. There is often a loud pop or click with immediate swelling and pain. It is common to not be able to walk or weight bear with a grade 3 ankle sprain. Swelling may appear like a lump in the shape of a tennis ball on the side of the ankle with bruising all along the ankle and foot.


In the early stages of injury, there may be a throbbing pain at rest and it is not unusual to have numbness or pins and needles in the toes as the large amounts of swelling. When weight-bearing the ankle can feel unstable.

Picture of Sprained Ankle Bruising

Ankle Sprain Diagnosis:


In most cases, a clinical assessment with a Physical Therapist is sufficient to establish a diagnosis for an Ankle Sprain. If a Physical Therapist is unsure of the severity of the sprain or wishes to exclude related conditions such as an avulsion fracture, they may refer for an MRI which is the most accurate form of scan for an Ankle Sprain. An ultrasound is a cost-effective alternative while an x-ray cannot diagnose an ankle sprain.

Home Management

We always recommend seeing a medical professional such as a Physical Therapist or a Sports Medicine Doctor if you have any symptoms of an Ankle Sprain. Where this is not possible, the best home remedy is the acronym PEACE & LOVE. 

P: Protect the area of injury for 1-3 days through offloading and a short period of rest. This allows the fibers of the torn ligament, a chance to begin the healing process.

E: Elevate the injured area to reduce swelling and inflammation in the affected area. This can lead to bruising up the leg but it is normal.

A: Avoid anti-inflammatory medication such as Ibuprofen as this can have a negative effect on the long-term healing of soft tissues. Our bodies have a very efficient set of healing stages and inflammation plays a key role in this so it should not be disturbed where possible.

C: Applying compression to the injured area with an elastic bandage can allow inflammation and swelling to occur but it can help to manage the volume of swelling.

E: Education in anatomy, healing response, and recovery process are vital. This enables optimal recovery by knowing what to do and not do during the phases of recovery.

L: Loading the injured area optimally helps to facilitate the healing process. On days 1-3 rest and offloading are beneficial but after this period, increasing activity levels within tolerable pain levels can help to promote and repair the injured ligament.

O: Optimism is important. Whilst it may feel like pain levels are having a significant impairment on quality of life, there is strong evidence to show that catastrophization, fear avoidance and depression can have a negative impact on the outcome of recovery.

V: Vascularisation through non-impact activities such as static cycling and swimming can help flush out toxins and reduce residual swelling from the area by increasing peripheral blood flow.

E: Exercise – a graduated strength, stability, and proprioception program is essential to restoring function and reducing the risk of injury recurrence.

Sprained Ankle Taping

Treatment for a Sprained Ankle

A Physical Therapist is in an excellent position to assess, diagnose and guide treatment for an ankle sprain. Treatment from a Physical Therapist may involve the following:

Ankle Ligament taping can help stabilize the ankle and allow the ligaments to heal in an optimal position. This may also be achieved using an ankle brace. In severe ankle sprains, a walker boot may be required in the initial phases to protect the ankle ligaments.

Manual therapy methods such as mobilisations, soft tissue massage, and mobalisations with movement may be used to reduce ankle stiffness and increase range of motion.

Strengthening exercises alongside balance, stretching and stability exercises may be prescribed with optimal graded exposure to variations of each exercise.

Hopping and plyometric exercise programs may be prescribed towards the end stages of rehabilitation, especially in cases where a return to sport is required.

A Steroid Injection can be necessary in cases where pain levels are too high and prevent rehabilitation. It is recommended that these be performed as an ultrasound-guided injection.

If conservative management fails, surgery may be required for an insufficient lateral ankle ligament. This is often a Brostrom repair to stabilize the lateral ankle ligaments.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

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