Ankle sprains are among the most common musculoskeletal injuries in the United States, with about 2 million cases reported each year. These injuries can occur from a simple misstep or awkward movement, putting significant strain on the ligaments that stabilize the ankle joint.
Dr. Travis Hanson, a foot and ankle surgeon at Houston Methodist, explained that while most ankle sprains heal without major issues when managed correctly, approximately 10 to 15 percent of people may develop chronic ankle instability after just one sprain. This condition increases the risk of repeated injuries, arthritis, and may eventually require surgery if not addressed.
Sprains can affect different parts of the ankle: lateral (outer), medial (inner), or high/syndesmotic (upper). Lateral sprains are most common and typically result from rolling the ankle outward. Medial sprains are less frequent but often more severe, occurring when the ankle collapses inward. High ankle sprains usually happen during intense athletic activities and involve injury to ligaments connecting the tibia and fibula.
The severity of an ankle sprain is graded from 1 to 3. Grade 1 involves mild stretching or small tears in ligaments and generally heals within two to three weeks with rest and basic support. “Grade 1 ankle sprains are usually pretty well-healed within two to three weeks,” said Dr. Hanson. “A lightweight over-the-counter ankle brace, home ankle-strengthening exercises and avoidance of certain activities for those two to three weeks are sufficient for most people.”
Grade 2 represents partial ligament tears and typically requires a walking boot followed by bracing and physical therapy over three to six weeks. Dr. Hanson noted: “For higher grade ankle sprains, I typically put patients in a walking boot for two weeks to really allow things to settle down and immobilize the joints… After two weeks, we’ll put them in a sturdy ankle brace and often initiate physical therapy.”
Grade 3 is characterized by complete ligament tears; these cases might prevent walking altogether but rarely need surgery if treated promptly. “We rarely perform surgery for an acute ankle sprain, even very bad sprains in high-grade athletes because the vast majority of these, when treated properly initially, will heal up and return back to normal,” Dr. Hanson said.
Several factors influence recovery beyond injury type or grade—such as age, overall tissue health, medication use like steroids that suppress healing responses, pre-existing joint flexibility issues, or returning too soon to activity after injury.
“Most ankle ligaments will heal, but sometimes they don’t,” said Dr. Hanson. He emphasized that resuming sports or other strenuous activities before full recovery could hinder healing: “If patients try to just grin and bear through the pain… they’re putting all sorts of strains on those ligaments as they’re trying to heal.”
For minor injuries without severe swelling or bruising where walking is still possible despite some pain, initial home care using rest, ice, compression, elevation (RICE), along with over-the-counter anti-inflammatory medications such as ibuprofen or naproxen may be effective.
“After a day or two… if you’re able to walk comfortably on your ankle… some home care for these very low-grade type of sprains is a reasonable thing,” Dr. Hanson stated. However he advised seeking medical attention if symptoms do not improve within this timeframe.
Chronic instability following repeated untreated or poorly managed injuries can lead to further damage including tendon tears or cartilage deterioration—eventually causing arthritis in the joint.
“If you develop chronic ankle instability… every time you do that you put yourself at risk of tearing tendons or injuring cartilage,” said Dr. Hanson.
Preventive strategies include wearing an appropriate brace during high-risk activities such as hiking on uneven terrain or playing sports like basketball; this helps limit excessive motion that could cause re-injury: “For certain patients it makes sense to wear an ankle brace… when they subject themselves to circumstances where they might be prone to rolling their ankle,” he said.
Strengthening muscles around the joint through targeted exercises can also help stabilize ankles—even though ligaments themselves cannot be strengthened directly—with routines such as drawing letters with toes while seated; plantar flexion; dorsiflexion; inversion/eversion movements; calf raises; single-leg balance drills; hops; toe curls; plus gradually increasing resistance via bands under professional guidance.
