Types of Ankle Sprains: A Complete Guide

It can be difficult to ascertain why your ankle hurts and whether it is a sprain or a fracture. A sprain is caused by a rapid stretch applied to a structure, usually a ligament, causing pain and inflammation to occur. A sprain is an overstretched or torn ligament due to an abnormal force experienced in a structure of the body. The most common area for sprains to develop is in the ankle complex due to its intricate nature and function in the body.

An ankle sprain usually occurs due to a sudden outward roll of the ankle when landing onto the foot. This outward roll of the ankle can cause injury through rapid overstretching of the ligaments, which are meant to maintain alignment of the bones in the ankle.

With repetitive overstretching of the ligaments in the ankle, the ligaments are lax and may not stabilize the bones of the ankles while walking or doing athletic activities, leading you to be prone to a more severe sprain.  Ligament laxity from repeated strains can increase the chances of a serious ankle injury or fracture in the future.

Causes of Ankle Sprains

The most common cause of ankle sprains is an outward rolling injury of the ankle when stepping down or landing onto the ankle. You can experience a sensation of instability in your foot when supporting the weight of your body that can occur at unexpected times during activities. However, an ankle sprain usually occurs when your muscles are fatigued and do not allow for correct ankle placement on the ground when weight is applied, leading to an uncontrolled movement of the ankle.

The risk of this increases when running or walking over uneven ground or when partaking in activities which require rapid change in direction or jumping movements. Obesity, pregnancy, and Ehlers-Danlos syndrome can all contribute to ligament laxity and being more prone to injury. Ankle sprains are associated with an increased risk of developing osteoarthritis in the joint.

Ankle injuries are graded according to the severity of the injury, which denotes the course and length of treatment before returning to normal activity or sport.

Grade 1 (Mild)

A grade 1 ankle sprain is characterized by the ligament fibers on the outer side of the ankle being stretched slightly, causing injury. The symptoms include minor pain and swelling on the outer side of the ankle. You may have slight visible bruising around the injury site. Pain usually subsides quickly and function isn’t limited for too long.

Initial symptoms of a grade 1 sprain can be treated effectively with the RICE method. Begin by resting the injured ankle and elevating the leg to reduce swelling. Ice and compression can further be applied to the injured ankle to reduce inflammation and pain.

Grade 2 (Moderate)

A grade 2 sprain involves a partial ligament tear within the ankle complex, causing prolonged pain and swelling in the area. This strain will prevent you from being able to take weight on the ankle and to walk without a limp. Bruising can also be noted around the outer side of the ankle, usually indicating a partial tear. 

Again, the RICE method can be followed initially to reduce inflammation and potential bruising. You can make use of medication to further manage the pain and inflammation you may be experiencing. A medical professional may advise that you immobilize the ankle using a brace or an orthotic boot to promote healing and provide support for the ankle. 

Grade 3 (Severe)

A grade 3 tear indicates a full rupture of one or more ligaments within the ankle structure. Significant pain and swelling is noted around the ankle, along with notable bruising. Putting weight on the foot is extremely painful, and you may not be able to walk for a period of time. Upon examination by a medical professional, instability is seen in the ankle, and provocation of your symptoms is relatively easy.

When to Seek Medical Advice 

Ruling out serious issues such as tendon rupture and bone fractures after sustaining an ankle injury will safely guide the healing process. You should seek medical advice if you have excessive bruising or swelling in the injured ankle. Another indication is that you are unable to put weight on the ankle without excessive ankle pain.


A medical professional may ask for an X-ray to be done to determine if there is an ankle fracture present based on his/her clinical examination. Surgery may be warranted to manage an ankle fracture.

Crutches to reduce weight off of the injured ankle are advised, usually in conjunction with a cast or boot to support the ankle. Thereafter, physical therapy is suggested to strengthen the muscles of the lower leg while providing a wider range of motion to the ankle. The physical therapist can also assist you with pain management and advance your therapy so you can return to sport safely. Exercise is advised to strengthen the muscles supporting the ankle complex after sustaining an ankle injury, especially if you've been in a cast or boot for a longer period of time.