Foot and Ankle Sprain

A foot or ankle ligament sprain occurs when a ligament (the strong band of tissue connecting bones) is stretched or torn, usually following a twist, roll or awkward landing. Sprains are common injuries, particularly during sport, exercise, or everyday slips and trips.

Most sprains improve well with the right treatment and rehabilitation, but some can cause ongoing pain or instability if not managed properly. At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and treatment planning to support recovery and reduce the risk of recurrence.

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Types of Foot and Ankle Sprains

Sprains are often graded by severity:

• Grade 1 (mild) – ligament stretched with minimal tearing, mild swelling and discomfort
• Grade 2 (moderate) – partial ligament tear, more swelling, bruising and difficulty weight-bearing
• Grade 3 (severe) – complete ligament rupture, significant swelling/bruising and instability

Common ankle sprains

• Lateral ankle sprain (most common)
  Usually occurs when the foot rolls inward (inversion), affecting ligaments on the outside of the ankle.
• Medial ankle sprain
  Less common and affects the deltoid ligament on the inside of the ankle.
• High ankle sprain (syndesmosis sprain)
  Involves ligaments between the tibia and fibula above the ankle joint. These can take longer to heal and may cause pain higher up the ankle, especially when twisting.

Foot sprains

Ligament sprains can also occur within the foot, often after a misstep, fall, or sports injury, and may affect the midfoot or toes.

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Common Causes of Foot and Ankle Sprains

Foot and ankle sprains commonly happen due to:

• Twisting the ankle on uneven ground
• Sports involving running, jumping or sudden direction changes
• Landing awkwardly from a jump
• Slips, trips or falls
• Wearing unsupportive footwear
• Previous ankle sprains (which can increase the risk of recurrence)

Some people may be more prone to sprains due to reduced balance, muscle weakness, or joint hypermobility.

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Symptoms of Foot and Ankle Ligament Sprains

Symptoms depend on the severity of the sprain, but commonly include:

• Pain around the ankle or foot (often worse when walking)
• Swelling and tenderness
• Bruising around the joint
• Difficulty weight-bearing or limping
• Reduced range of movement
• A feeling of instability or “giving way”
• A popping sensation at the time of injury (sometimes reported in more severe sprains)

If pain is severe, you cannot put weight on the foot, or the ankle looks deformed, you should be assessed promptly to rule out a fracture.

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis starts with a detailed assessment of your symptoms and injury history. Your consultant may:

• Examine the ankle/foot for swelling, tenderness, bruising and stability
• Assess range of motion and walking pattern
• Check for signs of ligament rupture or syndesmosis injury
• Arrange imaging where appropriate, such as:
  • X-ray to rule out a fracture
  • Ultrasound to assess ligament injury in selected cases
  • MRI scan for complex injuries, persistent pain, suspected high ankle sprain, or cartilage injury (scan at sister hospital)

This helps ensure the correct treatment approach and rehabilitation plan.

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Treatment & Recovery

Most sprains improve with conservative treatment, but recovery time depends on severity.

Early management (first 48–72 hours)

Your clinician may recommend:

• Rest and activity modification
• Elevation to reduce swelling
• Cold packs (short periods at a time)
• Support such as a bandage, brace or boot where needed
• Pain relief if appropriate

Rehabilitation and physiotherapy

Rehabilitation is essential for a strong recovery and to reduce recurrence. This may include:

• Gradual return to weight-bearing
• Strengthening exercises for the ankle and lower leg
• Balance and stability training
• Mobility work to restore range of motion
• Sport-specific rehabilitation when relevant

Bracing and support

Some patients benefit from ankle support during recovery, particularly when returning to sport or high-impact activity.

Ongoing symptoms

If pain, swelling or instability persists, further assessment may be needed to check for:

• Ligament rupture
• Cartilage injury
• Tendon involvement
• High ankle sprain
• Recurrent instability requiring additional treatment options

Surgical treatment (in selected cases)

Surgery is not common for most ankle sprains, but may be considered for:

• Severe ligament injury with ongoing instability
• Recurrent sprains despite rehabilitation
• Certain high ankle sprains or complex injuries

Your consultant will explain whether this is relevant based on your injury and recovery progress.

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When to seek urgent help

Seek urgent medical advice if you experience:

• Inability to put weight on the foot or ankle
• Severe pain or rapidly increasing swelling
• Significant deformity, or concern for fracture/dislocation
• Numbness, tingling, or a cold foot
• Pain and swelling that does not improve over time
• Repeated sprains or persistent instability

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If you have foot or ankle pain after an injury, or symptoms are affecting your mobility or recovery, contact Royal Buckinghamshire Hospital for assessment and treatment planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.