Ankle & Lower Leg

What It Is

Two line drawings of the ankle bones: from the outside, with short ligaments running from the lower end of the fibula down to the foot, and from the inside, with a broad fan-shaped ligament spreading down from the inner ankle bone. — The small ligaments on the outside of the ankle take most sprains; the broad one on the inside is much harder to strain.

Ankle sprains are one of the most common orthopaedic injuries and occur during a sudden, awkward twisting movement of the foot. As a result of these movements, the ligaments (strong bands of tissue that hold the ankle bones together) and other soft tissues of the ankle are stretched or torn.

An ankle sprain occurs when the ligaments of the ankle are stretched beyond their normal limits (AAOS, n.d.). Sprains are graded depending on the severity, and it may be advised to get a professional opinion.

Grade I sprains are when there is slight stretching and very small tears in the ligament. There are no signs of ankle instability. The ankle may be mildly swollen, bruised and tender, but there is usually little or no pain when you put weight on it.

Grade II sprains occur when there is partial tearing of the ligaments. There is moderate tenderness, bruising and swelling, mild pain when you put weight on the ankle, and the ankle may feel slightly unstable or loose.

Grade III sprains occur when there is a complete tear of the ligament. The ankle will be very swollen, tender and bruised, putting weight through it will be very painful, and the ankle will be clearly unstable (AAOS, n.d.). Even so, nearly all of these sprains can be treated without surgery (AAOS, n.d.).

On the inside (medial) side of the ankle, the deltoid ligament supports the ankle. On the outside (lateral) side there are three ligaments: the anterior talofibular, posterior talofibular and calcaneofibular ligaments.

The most common ankle sprain occurs when you roll over the outside of your ankle (the foot turns inwards). This is known as an inversion (lateral) sprain, and around 90% of ankle sprains are this type (AAOS, n.d.).

If you roll on the inside of your ankle (the foot turns outwards, which is less common), you may suffer an eversion (medial) sprain.

Causes of Ankle Sprains

Lateral ankle sprains often happen during weight-bearing activities when sudden changes of direction are required, when landing from a jump, or when walking or running on uneven surfaces. Sports such as basketball, tennis, football and trail running are common examples. The foot turns inwards too far, which stretches or tears the ligaments on the outside of the ankle (the anterior talofibular and calcaneofibular ligaments).

The mechanism of injury for medial ankle sprains is the opposite. The foot turns outwards too far, which damages the deltoid ligament on the inside of the ankle (AAOS, n.d.).

A previous ankle sprain, poor balance, and shoes that give little support or have slippery soles all increase the risk of a sprain (AAOS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Signs & Symptoms

Pain, both at rest and when you put weight on the ankle or are active
Swelling of the foot and ankle
Bruising around the foot and ankle
Tenderness to touch
Difficulty standing on the affected foot or walking comfortably
Decreased mobility of the ankle
The ankle feeling unstable, or as if it is giving way
With a severe tear, you may hear or feel a pop at the time of injury (AAOS, n.d.)

Treatment

Self-Care & Treatment

How to Manage Pain

For most ankle sprains surgery is not needed (AAOS, n.d.), and the following advice for the first 2 to 3 days may help reduce the pain and swelling (NHS, 2024):

Protection: protect the ankle, for example with a support or shoes that support your foot and ankle.
Rest: stop exercise and rest the ankle. Walking may be difficult for the first few days and crutches can help, but putting weight through the ankle as soon as you can tolerate it is usually encouraged (AAOS, n.d.).
Ice: wrap an ice pack (or a bag of frozen vegetables) in a tea towel and apply it for up to 20 minutes every 2 to 3 hours (NHS, 2024). Never put ice directly on the skin.
Compression: a bandage wrapped around the ankle during the day supports it and may help reduce swelling.
Elevation: keep the ankle raised on a pillow as much as possible to help minimise swelling.
Avoid heat (such as hot baths and heat packs), alcohol and massage for the first couple of days, as they can increase swelling (NHS, 2024).
Once you can move the ankle without pain stopping you, keep it moving gently so it does not become stiff (NHS, 2024).
Medication: the NHS (2024) suggests speaking to a pharmacist, and says that at first you can try painkillers such as paracetamol to ease the pain and ibuprofen gel, mousse or spray to bring down swelling, with ibuprofen tablets if needed. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Wear supportive shoes. Trainers or closed flat shoes that give the foot and ankle good support are best.
Avoid uneven or slippery ground in the weeks following an ankle sprain, as your ankle may be more likely to sprain again.

Rehabilitation

Exercise-based rehabilitation, usually including range-of-motion exercises, strengthening, balance (proprioception) training and then a gradual return to sport, is the most important part of recovery, and guidelines prefer it to passive treatments on their own (AAOS, n.d.; Vuurberg et al., 2018). I can guide you through this, with hands-on treatment alongside your exercises rather than instead of them. See the My Approach tab for how I work.

A previous sprain increases the risk of spraining the same ankle again, and without proper rehabilitation a severe sprain can leave the ankle weaker and more likely to be injured again (AAOS, n.d.). So doing the exercises I give you is really important. Most sprains feel better after about 2 weeks, but avoid strenuous exercise such as running for up to 8 weeks, and severe sprains can take months to get back to normal (NHS, 2024). Taping or a brace may help when you return to sport and can help prevent repeat sprains (AAOS, n.d.; Vuurberg et al., 2018). I can tape your ankle and help you work out whether a brace would help and how to get one.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Walking boot, brace or cast: for more severe sprains, a doctor may recommend a removable boot or brace, or occasionally a short cast, to support the ankle (AAOS, n.d.).
X-ray or other scans: a doctor may arrange an X-ray to rule out a broken bone, or occasionally an MRI scan to look at the ligaments and other soft tissues (AAOS, n.d.).
Stronger painkillers: a doctor may prescribe a stronger painkiller if needed (NHS, 2024).
Surgery: this is rare, and may be considered if the ankle stays unstable and painful after months of rehabilitation (AAOS, n.d.).

How I can help (see the My Approach tab)

A rehabilitation programme for movement, strength and balance
Hands-on treatment for the ankle and calf after the first few days
Taping and brace advice for your return to sport

Treatment

My Approach

Line drawing of the foot and ankle from the outside, showing tendons wrapping behind the outer ankle bone and along the side of the foot, held down by bands across the front of the ankle. — The muscles behind these outer-ankle tendons resist the foot rolling over — a big part of the strength work after a sprain.

After a sprain, the ligament needs protecting at first, then movement, strength and balance need rebuilding so the ankle doesn't keep giving way. Which path we take depends on how bad the sprain is.

If it's a mild or moderate sprain (grade I or II): you can usually put some weight on it, even if it hurts. I can treat it directly, following the stages below.

If it's a severe sprain (grade III): the ankle is clearly unstable, you can't walk more than a few steps, or you have any of the signs under When to Get Urgent Help. See a doctor first to rule out a broken bone. Once you've been checked, I work alongside your doctor's plan, including any boot or brace, and follow the same stages more slowly.

I start by assessing how your ankle moves, which ligaments are sore, your strength and balance, and how you walk.

The First Few Days

Rest, compression, elevation and ice at home (I'll show you how to use it safely)
No massage on the injured ankle for the first couple of days; after that, gentle drainage above it to help swelling move
Work on the rest of you, including the back and shoulders if you're on crutches
Pain-free movement of the toes, knee and hip, then drawing the alphabet with your big toe and towel scrunches

As It Settles

Trigger point work for a guarded calf, with warm and cool applications in the clinic
Cross-fibre work across the ligament to help it heal and stay mobile, followed by gentle joint movement
Pain-free holds pushing the foot in and out, then resistance-band work for the muscles around the ankle
Balance work: supported, unsupported, reaching, then on a cushion or balance board

Back to Full Activity

Joint mobilisation and soft tissue work for an ankle that is still stiff
Calf stretching once your ankle strength is back
A home programme and a gradual return to running and sport, with tape or a brace at first

If the ankle keeps giving way, or it is still swollen and painful well past the expected time, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: For a mild or moderate sprain, most people come once or twice a week for the first couple of weeks, then weekly, spacing out as you take over your home programme; most sprains feel better after about 2 weeks, but strenuous exercise such as running usually waits for up to 8 weeks. For a severe sprain, once a doctor has checked it, visits follow the same pattern alongside your doctor's plan, and getting back to normal usually takes months.

What I Focus On

Assessment

Early Protection

Ligament & Calf Work

Strength & Balance

Return to Activity

Please read

When to See a Doctor First

When to Get Urgent Help

Call 911 or go to the emergency room at your nearest hospital if you heard a crack when you were injured, your ankle or foot has changed shape or is pointing at an odd angle, your foot is numb, tingling or has pins and needles, or the skin around the injury has turned blue or grey or feels cold. These can be signs of a broken bone (NHS, 2024).

Get medical advice soon if the pain is severe or getting worse, there is a lot of swelling or bruising, you cannot put any weight on the ankle or walk more than a few steps, or it is not getting better after treating it yourself (NHS, 2024).

Sources

References

NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Sprained ankle. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/ (Accessed: 7 October 2026).
Vuurberg, G. et al. (2018) 'Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline', British Journal of Sports Medicine, 52(15), p. 956. doi: 10.1136/bjsports-2017-098106

Massage therapy · Kitchener–WaterlooAnkle Sprains (Medial and Lateral)

What It Is

Causes of Ankle Sprains

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage Pain

Rehabilitation

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

The First Few Days

As It Settles

Back to Full Activity

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAnkle Sprains (Medial and Lateral)

What It Is

Causes of Ankle Sprains

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Manage Pain

Rehabilitation

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

The First Few Days

As It Settles

Back to Full Activity

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Chronic Ankle Instability

Achilles Tendinopathy

Calf Strain / Calf Tear

Inversion Sprain of the Ankle

Book a session