What does a sprain damage?

When you roll your ankle outwards, the ligaments on the outside of the ankle get over-stretched or torn. That's the injury most people picture. It usually settles enough to walk on within days to weeks.

Why does it keep giving way after the pain has gone?

Because the ligament isn't the whole story. The current model of long-term ankle instability describes several linked parts that a sprain can affect [1]. Two of them are worth knowing about if your ankle keeps going over:

  • Your sense of position. How well you can feel where your foot is, especially on uneven ground.
  • Your movement control. How quickly and how well the muscles around the ankle react when it starts to tip.

If either one is dulled, the foot can land slightly wrong and the muscles can catch it slightly late, and the ankle can roll again. The same model also counts your confidence, any fear of it happening again, how active you stay, and the things around you.

Will my ankle always be weak now?

Not necessarily. The same model describes a range of outcomes a year or more after a sprain [1]. At one end are people who get back to full activity with no pain, no giving way and no repeat sprains. At the other end is chronic ankle instability: repeat sprains, a feeling that the ankle gives way, and less trust in it.

Where you end up isn't decided by the sprain alone. Balance and control training after a sprain lowers the chance of another one [3].

What makes a sprain more likely?

A 2018 clinical guideline lists these among the things that raise the chance of a sprain [2]:

  • a reduced sense of position at the ankle;
  • poorer balance standing on one leg;
  • a limited ability to bend the ankle upwards, so your knee can't travel far over your toes;
  • slower reactions in the muscles on the outside of the ankle.

When I see an ankle that keeps going over, these are the first things I test. Good rehab works on balance and control, stepped up gradually, rather than resting the ankle and hoping.

Do ankle braces help?

Yes. An overview of 46 research reviews found strong evidence that bracing lowers the chance of another sprain, and moderate evidence that balance and control training does too [3]. A brace isn't a sign of weakness. Wearing one for sport in your first season back is one of the best-supported things you can do. A physio or a pharmacist can help you choose one that fits in your boot.

Will I need surgery?

Usually not. The guideline says surgery should be kept for ankles that don't respond to thorough, exercise-based treatment [2].

What should I do now?

First, make sure nothing needs checking before you start. Go to an emergency department now if the ankle looks out of shape, or if your foot is cold, pale or numb. See a doctor or physio the same day if you can't take four steps on it, or if it hurts to press on the bones of the ankle or foot. When should you see a physio about a sprained ankle? has the full list.

If none of that applies, you're most likely dealing with a straightforward sprain, and the work that helps is balance and control training [3]: balance on one leg, then on softer and less steady surfaces, then hopping, landing and changing direction, with simple checks before you go back to full training.

This article is written for people aged 16 and over. If your child has hurt their ankle, have it checked by a doctor or physio.