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Ankle Sprains and Instability

What is an Ankle Sprain?

Most ankle sprains occur during sports or a misstep. The ankle becomes very swollen and it can be difficult to walk. Depending on how bad the ligaments and the tissues are damaged around the ankle the person may also notice some bruising. If people have a bad ankle sprain or repetitive ankle sprains they may go on to develop ankle instability. This is a condition where the ankle ligaments are no longer able to provide the extra stability to the joint and the individual roles their ankle so much it begins to inhibit their ability to do the activities that they would like to pursue.

What causes ankle sprains and instability?

How are sprains and instability treated?

The ankle is a very stable joint. The bones of the ankle interlock in a way that makes it very rigid. However, during certain activities or sports, a person may "roll" or "twist" the ankle in such a way that it stresses the ligaments around the joint. The main ligaments involved in most ankle sprains are the anterior talofibular ligament and the calcaneofibular ligament. When the ankle rolls it stresses these ligaments. We grade the type of sprain by the amount of damage to these ligaments.

Most ankle sprains improve with a period of rest, activity modification, ice, elevation, NSAIDs, and possibly a lace up brace. Physical therapy is very important to improve the muscles around the ankle to help compensate for the damaged ligaments while they heal. We typically get xrays to make sure there are no fractures if patients have difficulty walking after an ankle sprain. Thankfully, most patients do not need surgery for ankle sprains.

If the condition goes on to ankle instability, the patient may benefit from stabilizing surgery. The goal of surgery is to repair the damaged ligaments and support them so the patient has a stable joint.


1. Skelley, N. “Foot and Ankle Sports Injuries.” Presented at: Washington University in St. Louis Department of Orthopaedic Surgery Grand Rounds; Saint Louis, MO. August 2014.

2. Coetzee JC, Ellington JK, Ronan JA, Stone RM. Retrospective Chart Review of the Internal Brace Ligament Augmentation Repair in Conjunction with Open Broström Surgery in Ankle patients. Foot & Ankle Orthopaedics. 2016;1(1):2473011416S00268. doi:10.1177/2473011416S00268.

3. Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures of the Foot and Ankle in Athletes. Sports Health. 2014;6(6):481. doi:10.1177/1941738113486588.

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