Ankle Injuries in Sport: Not Just a Simple Sprain

As a Newcastle Sports Physiotherapist working with runners and athletes, I’ve seen my fair share of ankle injuries. Too often, people brush off their injury as “just an ankle sprain” and return to activity too soon, only to find themselves dealing with ongoing instability, chronic pain, or worse—requiring surgery that could have been avoided.

The reality? Not all ankle injuries are created equal. A forced inversion (rolling your ankle inwards) can result in a wide range of injuries, from the common lateral ligament sprain to fractures, cartilage damage, and high ankle sprains. The right diagnosis and rehab plan are crucial to ensuring a full recovery.

Lateral Ankle Sprains: More Than Meets the Eye

The classic ankle sprain involves the lateral ligament complex, which includes the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). These ligaments help stabilise the ankle, preventing excessive movement.

When these ligaments are overstretched or torn, we classify the sprain into three grades:

1. Grade 1: Mild tear, minimal swelling, and no joint instability. Recovery: 2-6 weeks with proper rehab.

2. Grade 2: Partial tearing of the ligament, moderate swelling, and some joint instability. Recovery: 4-8 weeks.

3. Grade 3: Complete ligament rupture, significant swelling, bruising, and ankle instability. Recovery: 8+ weeks, sometimes requiring immobilisation or even surgery if chronic instability develops.

While lateral ankle sprains are common, they’re not always simple. A poorly rehabilitated sprain can lead to chronic instability, increasing the risk of re-injury.

The 'Kissing Injury': Medial Ankle Compression

When the ankle rolls inward, the lateral ligaments stretch and tear—but what happens to the inside of the ankle? A medial impaction injury occurs when the talus (ankle bone) slams into the tibia, crushing the soft tissues in between & bruising the bone. This “kissing injury” can cause persistent deep ankle pain and stiffness.

If left undiagnosed, it can lead to osteochondral lesions—areas of cartilage damage in the talar dome that don’t heal well on their own. These injuries require careful management, often including a period of unloading in a boot to allow healing.

High Ankle Sprains: The Syndesmosis Injury

A more severe injury occurs when the foot is forced into excessive dorsiflexion (toes up) and external rotation. This can damage the syndesmosis, a set of strong ligaments connecting the tibia and fibula.

Unlike lateral ankle sprains, syndesmosis injuries don’t heal well with simple rest. They often require a boot for 6+ weeks to allow the ligaments to heal in a tight, stable position. In severe cases, surgical stabilisation with a screw or suture system (TightRope) is needed to prevent long-term instability.

Other Injuries That Mimic an Ankle Sprain

A forced inversion injury doesn’t just affect ligaments—other structures can take damage too. Some key injuries that might be missed:

• Talar Dome / Tibial Plafond Injuries: Impact damage to the cartilage surface of the talus or tibia, leading to chronic pain and swelling.

  
  

• Midfoot Sprains (Lisfranc Injuries): If the force extends into the midfoot, it can sprain or even dislocate the Lisfranc joint—critical for foot stability.

  
  

• Subtalar Joint Injuries: The joint beneath the ankle (subtalar joint) can be sprained, leading to pain with side-to-side movement.

  
  

• Fractures: Small avulsion fractures (where a ligament pulls off a piece of bone) or even more severe fractures like a fibular fracture (Weber B/C) can occur.

  
  

• Peroneal Tendon Injuries: The peroneal tendons, which run along the outside of the ankle, can be overstretched or even sublux (move out of place) after an inversion injury.

Rehab Matters: The Cost of Ignoring an Ankle Injury

Returning to sport too soon after an ankle injury can set an athlete up for failure. If structures heal too loose, chronic instability develops, making the ankle prone to repeated sprains.

In cases of syndesmosis injuries, severe ligament tears, or talar dome lesions, wearing a boot allows the structures to heal in an optimal position, preventing long-term complications. Without proper management, surgery may become necessary to correct instability that could have been avoided.

Final Thoughts: When to Seek Help

If you’ve rolled your ankle and experience significant swelling, bruising, inability to bear weight, or deep joint pain, get it checked. Ankle injuries that seem minor can have hidden complications, and the right treatment can mean the difference between a quick recovery and a long-term problem.

As a sports physiotherapist, my role isn’t just to treat injuries but to help athletes return to their sport stronger and more resilient than before. If you’re dealing with an ankle injury that isn’t improving, don’t ignore it—get the right assessment and treatment so you can move with confidence again.

We also believe in a multidisciplinary approach, liaising with other professionals to get the best results, such as:

• Kurt Robertson, Leading Podiatrist at https://newcastlepodiatry.com.au/about

• Dr Pankaj Rao, Foot & Ankle Orthopaedic Surgeon & Specialist at https://www.rao.net.au/

This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!

You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com

Bookings also available on our website for:

• Dietitian - weight-loss or to optimise your training nutrition / fueling

• VO2 Max testing - to discover more effective ways to train efficiently

• Strength & Conditioning Programs - contact us via the website or email us at upnadamptphysio@gmail.com

• Remedial Massage - to relieve accumulative muscle tightness from chronic pain or from training that could lead to injury.