An ankle sprain is one of the most common sports injuries, often occurring when the foot rolls inward during walking, running, or athletic activity. While ankle sprains are frequently described as “minor,” understanding how and why an ankle sprain occurs is essential for proper recovery and long-term ankle health.
This article explains the mechanism of injury, anatomy, and structures involved in an ankle sprain, as well as common signs and symptoms to watch for. Written by a Markham physiotherapist, this guide is designed to help you better understand ankle sprains and recognize when professional assessment or physiotherapy may be appropriate.
What Is an Ankle Sprain?
An ankle sprain occurs when one or more ligaments supporting the ankle are overstretched or torn. These ligaments help control movement and provide stability during walking, running, and sport.
Ankle sprains are especially common in sports that involve:
- Jumping and landing
- Cutting and pivoting
- Uneven playing surfaces
Ankle Sprain Anatomy: Understanding the Injured Structures
The Talocrural Joint and Ankle Sprains
The ankle joint is medically referred to as the talocrural joint. It is formed by the lower ends of the tibia and fibula, which create the bony prominences on the inside and outside of your ankle—known as the medial and lateral malleolus.
Between these bones sits the talus, forming a joint that allows movement such as:
- Walking
- Squatting
- Rising up onto your toes
- Jumping and running
This joint plays a critical role in absorbing forces during sport and daily activities.
The Subtalar Joint and Ankle Sprains
Below the talus lies the calcaneus (heel bone). Together, the talus and calcaneus form the subtalar joint.
The subtalar joint allows the foot to:
- Adapt to uneven surfaces like grass or sand
- Rotate during walking and running
- Transfer force efficiently during jumping and cutting movements
Restricted or poorly controlled movement at this joint can contribute to foot, heel, or ankle pain and may increase the risk of recurrent ankle sprains.
Ankle Sprain Ligaments Most Commonly Injured
Lateral Ankle Sprain Ligaments
The outer (lateral) side of the ankle contains several important ligaments that limit excessive rolling of the foot.
From front to back, these include:
- Anterior Talofibular Ligament (ATFL)
- Calcaneofibular Ligament (CFL)
- Posterior Talofibular Ligament (PTFL)
These ligaments work together to stabilize the ankle, but each is stressed at different ankle positions during injury.
Other ligaments that may also be injured during an ankle sprain include:
- Ligaments of the subtalar joint
- Ligaments of the distal tibiofibular joint
A trained sports injury physiotherapist can assess all of these structures to determine the full extent of the injury.
Types of Ankle Sprains (Lateral Ankle Sprains)
A lateral ankle sprain occurs when the foot rolls inward (inversion). This is the most common type of ankle sprain seen in sports.
Different ligaments are typically injured depending on foot position at the time of injury:
- ATFL: Commonly injured when the foot is on the ground and slightly in front of you
- CFL: More likely injured when the foot is directly underneath the body
- PTFL: Less commonly injured, but more vulnerable when the ankle inverts in a squat or when the leg is behind the body
Physiotherapists use specific clinical tests to assess each ligament individually. The amount of ligament looseness helps determine the grade of the sprain:
Grade 1: Mild ligament strain
Grade 2: Partial ligament tear
Grade 3: Complete ligament tear
Signs and Symptoms of an Ankle Sprain
Common symptoms include:
- Pain around the ankle
- Swelling
- Difficulty walking or bearing weight
- Bruising
- A feeling of instability or “giving way”
More severe ankle sprains often result in increased swelling and pain and may prevent continued participation in sport.
Do Ankle Sprains Need X-Rays?
In most cases, X-rays are not required for ankle sprains. Clinical decision tools such as the Ottawa Ankle Rules are used to determine when imaging is necessary.
An X-ray may be recommended if:
- There is pain in the ankle or midfoot and
- There is bone tenderness over:
- The medial or lateral malleolus
- The base of the 5th metatarsal (outer foot bone)
- The navicular bone (inner foot bone)
- Or if you're unable to take four steps immediately after the injury and during clinical assessment
A physiotherapist trained in sports injuries can help determine whether further medical imaging is required.
Physiotherapy for Ankle Sprains in Markham
Physiotherapy for ankle sprains focuses on:
- Reducing pain and swelling
- Restoring range of motion
- Improving strength and balance
- Preventing future ankle injuries
- Guiding a safe return to sport or activity
If you’ve experienced a rolled ankle or ankle sprain, especially during sport, early physiotherapy assessment can help ensure proper healing and reduce the risk of long-term issues.
You’re not alone
Have you been unable to return to your usual self after an ankle sprain? Have you had repeated ankle sprains that have been progressively limiting you? The physiotherapists and massage therapists at Family Physiotherapy have the experience and training to get you back to achieving your health and wellness goals! Contact us for a consultation. Don’t let pain ruin your day!
