Ankle Sprains and Instability

Ankle Sprains

A seemingly minor injury: an ankle sprain. Convincing people of the severity of an injury is seldom a good strategy in healthcare. Ankle sprains resulting in chronic ankle instability are frequent, easy to rehab properly but could lead to osteoarthritis. It’s important to regard ankle sprains as important because it could result in surgical treatment if untreated. There is good reason for this blog – around 55% of people who suffer from ankle sprains do not consult a medical professional which probably explains the high percentage of patients who experience chronic ankle instability.

Ankle sprains are the second biggest reason for A&E visits. The NHS predicts they see 302,000 new ankle sprains and 42,000 severe new ankle sprains a year. About 80% of all ankles sprain more than once, and 20% of ankle sprains turn chronic. If you have chronic ankle instability you sprain the ankle a lot. It can also feel unstable, painful around the ligament area and the ankle clicks a lot.

So what happens? The incident can damage the ligaments shown on the image next to the text. 66% of ankle sprains only damage the anterior talofibular ligament, but you could damage other ligaments also.


  • Good stability without laxity but tender – Grade 1
  • Partial tear, laxity at the end of movement – Grade 2
  • Rupture, gross laxity and instability – Grade 3

The typical reason for ankle sprains is stepping off uneven surfaces, bad challenges in sport, or awkward landings from falls. If you’re unlucky and you have chronic ankle instability the sprain can occur even when walking.

When do I require an X-Ray?

It is very frustrating when you damage your ankle and go to A&E only to find out you have a 4 hour waiting list and at the end of it all you’ve only sprained the ligaments. Don’t be put off from seeking medical assessment, so this blog is designed to inform you on this subject.

X-rays are a good way of finding fractures, but they are at the bottom of the A&E concern list. This does mean there will be a big waiting time in A&E. If it is broken the tests shown in the attached video would be positive alongside the facts given at the case history. If there is no sign of a fracture then rehab can start straight away, and at the Movement and Wellbeing Clinic we can offer a more holistic support mechanism than NHS physiotherapy.

What we look out for during assessment:

  1. Inability to weight bear
  2. High impact injury, such as a motorbike accident or after a heavy sporting challenge
  3. Bony tenderness
  4. A lot of swelling/bruising

You will need to present with an accumulation of these factors, rather than just one. As with most things, get your Osteopath’s or anther allied healthcare practitioner’s opinion rather than judge for yourself.

A twist in the tale

We’ve found out the stats behind ankle instability and the subsequent anatomy behind it. New research has come to light that suggests the ligament may not be the source of the problem, despite the area of tenderness. The fibula bone that is involved with ankle injuries may have a positional fault due to the impact. Studies show this fault when they X-Ray damaged ankles.

Another fact that supports this is that the swelling in an ankle sprain is inside the joint, whereas the ligament is on the outside. Logically, damage to the ligament would result in swelling on the outside of the joint. There will be damage to the ligaments, but some experts in the field believe a more serious injury occur. The fibula head can be wrenched forwards, causing damage at the joint between the fibula and tibia.

As an osteopath, I offer the explanation and find the most suitable way of treating your individual injury.

Finally, how is this resolved?

Ankle sprains require appropriate self-care (namely MEAT), as well as osteopathic adjustment and an exercise program to ensure full recovery.

If you want to avoid ankle sprain re-occurrence, possible osteoarthritis and optimise your performance don’t hesitate to get in touch.

For any further questions, please don’t hesitate to ask:

0161 209 2980

Ed Madeley M.Ost