Ankle sprains are the most common sports injury. Lateral ankle ligaments, which provide resistance against inversion and internal rotation stress, are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Medial supporting ligaments are the superficial and deep deltoid ligaments, which provide resistance to eversion and external rotation stress and are less commonly injured.

Ankle sprains are graded according to severity as follows with tenderness observed on the specific location of the ligaments:

Grade 1 sprain involves the ATFL with stretching of the ligament, slight local swelling and bruising, no instability of the ankle and full or parital weight bearing capabilities.

Grade 2 sprain involves the ATFL and the CFL, with paritial tearing of ligaments, moderate local swelling and bruising, possible instability of the ankle, and difficult weight bearing without crutches.

Grade 3 sprain involves the ATFL, CFL and PTFL with complete tear(s) of ligament(s), severe swelling and bruising, instability of the ankle, and impossible weight bearing without extreme pain. Surgical treatment is a strong possibility with Grade 3.

A physician visit is necessary to get proper diagnosis and early treatment to promote early healing and rehabilitation. Often early exercises are recommended to promote the best healing, but stabilization protection is required to prevent another mishap. A physician visit is also important to rule out other possible injuries, such as ankle fractures and tendon injuries.

Is the Ankle Broken or Fractured?
This is the most common question regarding severely sprained ankles due to inversion. Only x-ray images can tell for sure. However, the following signs signal a fracture: obvious deformity, weight bearing is impossible, slight squeezing or touching of the malleoli (the knobs on each side of your ankle) cause a lot of pain or there is extreme pain from touching along the outer edge of the foot (between the little toe and the heel). It is important to see a physician, nevertheless. Keep in mind that even physicians can miss reading an x-ray if the fracture is unusual, involves a tendon avulsing the bone, or there is an occult (hidden) fracture.

Prevention
Faster running speed, better cardiorespiratory endurance, good balance, stronger dorsiflexion strength, better overall coordination, quicker muscle reaction, and greater dorsiflexion range of motion at the ankle may be important factors to develeop to prevent ankle sprains.

Ankle eversion strengthening (peroneus longus and peroneus brevis) and improved reaction time of ankle eversion muscles may also be helpful. Also consider that eversion strengthening and speed and reaction training does not lag behind dorsiflexion strength, speed and quickness.

Also balancing on one leg on stable and unstable surfaces is considered (hopping for prevention and extra care on hopping post-injury).