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Ankle sprain

Also called lateral ankle sprain, sprained ankle, inversion sprain, lateral ligament sprain

An injury to the ligaments on the outer side of the ankle, usually from rolling the foot inward. How research defines it, who it affects, how it tends to go, and what trials of casts, braces, exercise and surgery found.

Region
Foot & ankle
Updated
September 30, 2026
Reviewed
September 30, 2026 · how entries are checked

What it is

How researchers define it

A position statement from the International Ankle Consortium endorses one definition1. It calls an ankle sprain a sudden injury to the lateral ligament complex, the ligament group on the ankle’s outer side1. The cause is too much inversion (turning the sole of the foot inward) of the rear foot1. It can also come from plantar flexion (pointing the foot down) combined with adduction (moving the foot toward the body’s midline)1. The statement adds that it usually brings some early loss of function1.

The lateral ankle ligaments are three: the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments6,7. In this kind of sprain, the ATFL is the first or only ligament damaged, and the CFL is the next most often hurt6,8.

Engraving of the right ankle and foot seen from the outer side. Just above the ankle, short bands labelled the anterior and posterior lateral malleolar ligaments (older names for the anterior and posterior tibiofibular ligaments) bind the lower end of the fibula to the tibia. Below them the anterior talofibular, calcaneofibular and posterior talofibular ligaments fan out from the outer ankle bone to the talus and heel bone, with the ligaments of the midfoot beyond.
Ligaments of the ankle and foot from the outer sideHenry Vandyke Carter, in Henry Gray, Anatomy of the Human Body (1918), Fig. 355. Public domain, via Wikimedia Commons. (source, Public domain)

In one meta-analysis (a study that pools several earlier studies), outer-side sprains were the most common type9. Their risk was significantly higher than for inner-side (deltoid) sprains or high ankle sprains (sprains just above the ankle joint)9.

When problems last: chronic ankle instability

Chronic ankle instability involves a loose, unstable ankle that gets in the way of activity10. It can follow one sprain or repeated injuries to the outer ligaments10. For research, the consortium describes it as at least one significant sprain, the first at least 12 months earlier1. Added to that is a history of the ankle giving way, repeat sprains or feelings of instability1.

The consortium defines “giving way” as regular, uncontrolled, unpredictable episodes of the rear foot turning too far inward1. These episodes do not cause a new sprain1. The consortium wrote these criteria because studies had picked participants inconsistently, which limits how far their findings apply1. A 2018 consortium statement describes the condition as growing from mechanical and sensorimotor (sensing and controlling movement) problems that appear after a sprain2.

Who it affects

How common it is

A review of 227 studies covering 70 sports found the ankle was the most often injured body site in 24 of them11. Ankle sprain was the main ankle injury in 33 of 43 sports11. The consortium’s position statement cites an estimate that up to 55% of people who sprain an ankle do not see a health professional1. So health records may undercount sprains1.

Group studiedWhat was found
US emergency departments, 2002 to 20062.15 sprains per 1,000 person-years (people multiplied by the years each was followed), highest at ages 15 to 1912
25 US college sports, 2009-10 to 2014-15The most often reported injury, 7.3% of all injuries13
751 adults aged 18 to 65 in New South Wales, Australia15.6% had a long-lasting ankle problem of muscles, bones or joints caused by injury14

Sex, age and sport

A meta-analysis of 181 studies found sprains were more frequent in females than males9. It also found them more frequent in children and teenagers than in adults9. Indoor and court sports had the highest rate of any sport group9. A review of risk factors found the most support for a past ankle injury15. It found the highest risk in athletes in court and field sports15.

Repeat sprains and lasting problems

A narrative review reports that people with a past sprain have about 3.5 times the risk of another10. It reports that 12% to 47% of sprains are repeats10. The consortium’s position statement reports repeat rates as high as 80% in high-risk sports1. It also reports that 32% to 74% of people with a past sprain have lasting symptoms, repeat sprains or both1.

Studies count chronic ankle instability after a sprain or across a whole group16,17:

  • Cochrane review, after a sudden sprain: 10% to 20%16.
  • Cohort study (following a group over time), after a first sprain: 40% at one year, as a narrative review reports it10.
  • Whole group, 2,175 Japanese college athletes from 12 sports: 52.9% had had a sprain and 17.9% met the consortium’s criteria18. It was most common in basketball and handball18.
  • Whole group, 829,791 young adults before military service: 0.7% mild and 0.4% severe in males, 0.3% and 0.4% in females17.

In those young adults, higher body mass index (a measure of weight for height) and greater height were each linked with it in both sexes17.

A consortium review links lasting problems after a sprain with lower activity, lower quality of life and rising rates of osteoarthritis after injury19. Osteoarthritis is a long-term joint disease in which the cartilage lining the joint wears away. In a Korean national insurance group of 195,393 people, those with a recorded sprain had a 46% higher rate of later ankle osteoarthritis20.

What studies found

How it changes over time

A review of 31 studies, 24 of them high quality, followed adults given usual care after a sudden outer-ankle sprain3. Reported pain fell quickly in the first 2 weeks3. Between 5% and 33% still had pain after 1 year3. Repeat sprains were found in 3% to 34%, recorded from 2 weeks to 96 months after injury3.

A systematic review (a study that searches for all the research on a question in a set, checkable way) looked at first sprains21. Its 15 studies showed lasting pain and felt instability falling over the first year21. By 12 months, 15.8% had sprained the ankle again21.

Still with pain (%)3 months48.6 6 months21.5 12 months6.7
Still with pain (%). Bars start at zero; the table below gives each value with its source.
Time after a first sprainStill with pain (%)Still feeling unstable (%)
3 months48.62137.921
6 months21.52116.121
12 months6.7218.121

In 44 adults followed an average of 204 weeks after a sprain, 18.1% had injured the ankle again22. On examination, 45.5% had pain around the ankle22. A quarter, all of them athletes, showed signs of anterior ankle impingement, a pinching at the front of the ankle22.

A cohort followed 82 people after a first sprain23. At 2 weeks, some could not complete a single-leg drop landing and a drop jump (a jump straight up right after landing from a box)23. This predicted instability at 12 months23. That test sorted 67.6% of cases correctly23.

Casts, supports and early exercise

A Cochrane review names three main approaches: a cast or splint, early movement with a support such as a brace, and surgery4.

One randomised trial (groups assigned by chance, then compared) included 584 people with severe sprains from eight UK emergency departments24. A 10-day below-knee cast gave faster recovery than a tubular compression bandage24. Ankle function was 9% better with the cast at 3 months24. A brace-style boot gave no benefit over the bandage24. At 9 months, no support differed significantly from the bandage24.

A randomised trial included 101 people with a grade 1 or 2 sudden sprain25. An early exercise group had better self-reported ankle function at weeks 1 and 2 than a group given protection, rest, ice, compression and elevation25. Pain and swelling did not differ between the groups25.

An overview of 46 systematic reviews looked at pain, swelling and function after a sudden sprain5. It found strong evidence for anti-inflammatory drugs (NSAIDs) and early movement5. It found moderate evidence for exercise and manual therapy (hands-on methods such as massage or moving a joint by hand)5. A 2018 Dutch guideline says anti-inflammatory drugs may reduce pain and swelling26. It adds that they have complications and may hold back natural healing26.

Braces and training against repeat sprains

A randomised trial included 522 athletes aged 12 to 70 after a sprain27. One group did eight weeks of home proprioceptive training (training the sense of joint position)27. Within a year, 22% of them reported a repeat sprain, against 33% of the comparison group27.

Another trial split 384 athletes into three groups after a sprain28. The share reporting a repeat sprain within a year was28:

  • 8-week home training: 27%28.
  • Brace: 15%28.
  • Brace and training combined: 19%28.

Against training, bracing cut the number of repeat sprains but not how severe they were28. Time lost and costs did not differ between groups28.

A meta-analysis of 7 randomised trials, with 1,417 people, looked at exercise-based programmes after a sudden sprain29. At 7 to 12 months they were linked to fewer repeat injuries than usual care29. The odds ratio (how many times higher the odds are) was 0.5329. At 3 to 6 months the difference was not significant29. Programme time ranged from 3.5 to 21 hours, and the authors found no agreement on the best content or amount29.

The overview of 46 reviews found strong evidence that bracing reduced repeat sprains5. It found moderate evidence for neuromuscular training (exercise that trains nerves and muscles to work together)5. The 2018 Dutch guideline describes braces as an effective option against repeat outer-ankle sprains26.

Surgery

The Cochrane review of 20 trials compared surgery with non-surgical care for sudden outer-ankle ligament injuries4. Its 2,562 people were mostly young, active adult men, and every trial had weaknesses in its methods4. Apparent gains for surgery included fewer repeat sprains, less long-term pain and less instability4. These did not hold up in a second way of pooling the trials, or when one low-quality trial was removed4.

The same review found some limited evidence of longer recovery, more stiffness, less mobility and more complications after surgery4. It concluded the trials give too little evidence to judge the two against each other4. The overview of 46 reviews also found conflicting evidence on surgery for sudden sprains5.

Studies in chronic ankle instability

A Cochrane review of 10 randomised trials looked at people with chronic ankle instability16. In four of its trials, neuromuscular training gave better ankle function scores than no training after four weeks, and longer-term data were not available16. It found too little evidence to favour any one operation over another16. One trial of 40 people compared tenodesis (surgery that reattaches a tendon to bone) with anatomical reconstruction, which rebuilds the ligament in place16. Nerve injuries were more common after tenodesis16.

Connections

The injury centres on the lateral ankle ligaments, one of three ligament groups that steady the ankle joint30. The other two are the syndesmosis between the shin bones and the deltoid ligaments on the inner side30.

Related exercise pages: drop landing, single-leg squat. A meta-analysis of 21 studies looked at single-leg landings in people with chronic ankle instability31. They landed with the foot more pointed and less knee and hip bend than controls31. They also had less activity in the peroneus longus, an outer-leg muscle, just before landing31.

Two small studies of people with chronic ankle instability measured gluteus maximus (the large muscle of the buttock) activity in different squats32,33. One, of 48, found more in the single-leg squat test than healthy controls and people who had recovered well from a sprain32. The other, of 18, found less than healthy people in a rotational squat33.

Ankle sprain involves

Ankle sprain is compared with injuries of

Ankle sprain has been studied in people with

Sources

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Every source the library cites

Changes

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