Ankle Sprains: Acute Pain and Injuries

What You Need To Know

A clear look at how ankle sprains happen, what they feel like, and when to seek care.

Understanding Ankle Sprains

An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs in isolation.

These injuries occur when the ankle is twisted underneath the leg, called inversion. This usually occurs due to an inversion injury, which means the foot rolls underneath the ankle or leg. It commonly occurs during sports, particularly activities like basketball and jumping sports, in which an athlete can come down on and turn the ankle or step on an opponent’s foot.

Patients report pain after having twisted an ankle. Patients will complain of pain on the outside of their ankle and various degrees of swelling and bleeding under the skin (i.e. bruising). Technically, this bruising is referred to as ecchymosis. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.

Because a sprain can occur alongside a fracture, and because untreated ligament injuries can lead to lasting instability, patients who cannot bear weight, have significant swelling, or notice ongoing pain after a twisting injury should be evaluated by a foot and ankle specialist to confirm the diagnosis and begin appropriate care.

Risk Factors and Recurrent Sprains

Some people are predisposed to ankle sprains due to the underlying structure of the foot. In people with a hindfoot varus, which means that the general nature or posture of the heels is slightly turned toward the inside, these injuries are more common. This is because it is easier to turn on the ankle when the heel already sits in a slightly inverted position.

A prior history of ankle sprains is another significant risk factor. In those who have had a severe sprain in the past, it is also easier to turn the ankle and cause a new sprain. Therefore, one of the risk factors of spraining the ankle is having instability. Once the supporting ligaments have been stretched or torn, the ankle may not return to its original level of stability without focused rehabilitation.

Muscle weakness also plays a role. Those who have weak muscles, especially those called the peroneals which run along the outside of the ankle, may be more predisposed to sprains. The peroneal muscles help resist the inward rolling motion that causes a lateral sprain, so when they are underconditioned, the ankle loses an important layer of dynamic protection.

Understanding these risk factors matters because it shapes long-term recovery. Patients who address underlying alignment, strengthen the peroneals, and restore stability after a sprain are far less likely to face recurrent injuries and can return to sport and daily activity with greater confidence.