Lateral ankle sprains are the most common ankle injuries seen in both competitive athletes and recreational exercisers. These sprains typically occur when the ankle rolls inward at speed, placing excessive strain on the outer (lateral) ligaments of the ankle.
The Ligaments Involved
Most lateral ankle sprains affect one or more of the following ligaments:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
The ATFL is the most commonly injured of the three, making it particularly vulnerable during rapid changes in direction or uneven landings.
Signs and Symptoms
A lateral ankle sprain often presents with:
- Swelling
- Bruising (ecchymosis)
- Decreased range of motion
- Muscle weakness
- Joint instability
- Point tenderness along the lateral ankle
Clinical Examination
A medical professional may perform several manual tests to confirm the severity and structures involved:
- Anterior drawer test
- Talar tilt test
- Comparison of muscle strength between sides
- Assessment of range of motion differences
Ottawa Ankle Rules
These guidelines help clinicians determine whether X-rays are needed to rule out a fracture. Radiography should be considered when there is:
- Point tenderness at the lateral malleolus
- Point tenderness at the medial malleolus
- Point tenderness at the base of the 5th metatarsal
- Point tenderness at the navicular
- Inability to bear weight for 4 steps immediately after injury
Karlsson Ankle Function Score (KAFS)
The KAFS helps clinicians track symptoms, functional limitations, and perceived stability throughout recovery.
Interpretation:
- 80–100 → Excellent to good function
- 60–79 → Fair function
- <60 → Poor function or increased instability
Common Uses:
- Monitoring rehabilitation progress
- Assessing surgical outcomes
- Tracking chronic ankle instability
- Supporting return-to-sport decisions
Grading of Lateral Ankle Sprains
| Grade | Ligaments | Weight Bearing | Estimated Recovery |
| Grade I | Mild stretch | Normal | 1–4 weeks |
| Grade II | Partial tear | Painful but stable | 2–8 weeks |
| Grade III | Complete rupture | Unstable | 12 weeks–12 months |
Rehabilitation and Recovery
If surgery is not required, rehabilitation typically begins with protecting the ankle and reducing inflammation, followed by gradual reloading and mobility work.
Phases of Rehabilitation for a lateral ankle sprain
1. Acute Phase (0–2 weeks)
Goals Include:
- Reducing swelling
- Improving mobility
- Encouraging early weight bearing
- Use of ankle brace depending on severity
- Physiotherapy interventions such as ultrasound and trigger point release
2. Early Strengthening Phase (2–4 weeks)
Goals include:
- Strengthening Evertors and invertors
- Strengthening Dorsiflexors and plantarflexors
- Strengthening Toe flexors and extensors
Exercises typically start isometrically, progressing to concentric and eccentric work. Ankle mobility and early proprioception are gradually reintroduced.
3. Intermediate Phase (4–6 weeks)
Goals include:
- Increasing resistance during strengthening
- Introducing unstable surface training
- Single-leg exercises
- Strengthening the kinetic chain (glutes, quadriceps, hamstrings)
- Progressing to single-leg calf raises
4. Advanced Phase (6+ weeks)
At this point, rehabilitation becomes more functional and sport-specific:
- Running is introduced
- Multi-directional movements and agility work
- Task-specific drills based on the athlete’s goals
The PAAS Framework for Return to Sport
A comprehensive return-to-sport assessment should evaluate Pain, Ankle function, Athlete perception, and Sensorimotor control, followed by Sport performance testing.
The PAAS framework includes detailed assessments such as:
- Pain during walking, jogging, running, hopping, and cutting
- 24-hour pain response
- Range of motion, strength, and ligament stability testing
- Athlete confidence and psychological readiness
- Balance tests, Y-Balance, landing mechanics
- Hop tests, agility drills, and sport-specific movement patterns
Passing criteria generally require:
- Symmetry of 90–95% or more
- Pain ≤1/10 during functional tasks
- No swelling increase
- Stable mechanics without movement faults
- High athlete confidence
Only once all criteria are met should an athlete be cleared to return to full sporting activity.
For the Full Program:
Available now in our premium membership portal — My Next Move.
🎯 For only R250/month, you get:
- This ankle program + new programs every month
- 1x online consult to guide your journey (15-20 minutes)
- Access to our symptom tracker and referral support
- Slow Movement programs
If you have any questions or would like to learn more about My Next Move or today’s blog topic, don’t hesitate to reach out to us at info@traversehealth.co.za.
Yours in health,
The Traverse Health Team
