Acute Ankle Injuries (Sprains & Fractures)

Acute ankle injuries

Acute ankle injuries are sprains, strains, and fractures which occur suddenly as opposed to developing gradually over time. If you have a particularly severe injury or suspect it might be broken then seek medical advice as soon as possible.

When should I see a doctor?

The majority of acute ankle injuries can be treated at home. However, if you have any of the following symptoms then seek medical advice.

  • Severe ankle pain
  • Severe swelling
  • You heard a pop or crack at the time of injury
  • The ankle locks
  • Altered sensation including numbness or pins and needles
  • If you have applied the PRICE principles for three days and still have severe pain
  • If you still have discomfort or weakness in the ankle after two weeks

Read more about when to see a doctor.

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Sprained ankle

Acute Ankle Injuries

An ankle sprain is one of the most common sports injuries1,2. It is also one of the most frequently recurring acute ankle injuries, especially if it is not rehabilitated properly.

  • Symptoms include instant pain and swelling.
  • Bruising can appear immediately or may develop over the following 48 hours.
  • Ankle sprains are graded 1, 2 or 3. A Grade 1 is a mild injury with some pain, but little or no swelling.
  • A grade 2 sprain causes moderate to severe pain.
  • A grade 3 is a complete, or near-complete, tear of the ligament.

Read more on Ankle sprains.

Eversion Ankle Sprain

An eversion ankle sprain is rare and occurs when the ankle rolls too far inwards.

  • The ligaments on the inside of the ankle are torn.
  • An eversion sprain often occurs in conjunction with a fractured fibula bone.

Read more on Eversion ankle sprain.

High Ankle Sprain

high ankle sprain - tibiofibular ligament

A high ankle sprain is a tear of the anterior tibiofibular ligament at the top of the ankle. A high ankle sprain is likely to be more severe and difficult to treat.

  • Symptoms of a high ankle sprain include pain on tibiofibular ligament as well as swelling or bruising.
  • The patient will have difficulty walking. Severe injuries can also cause damage to the membrane connecting the Tibia and Fibula (called the syndesmosis).
  • A high ankle sprain sometimes occurs with a fracture of one of the lower leg bones.

Read more on acute High ankle sprain.

Pott’s Fracture, Broken Ankle & Dislocations

Acute ankle injuries - Potts Fracture

If you suspect a broken ankle then seek professional medical advice as soon as possible. A Pott’s fracture is a fracture to one of the bony parts of the ankle called the malleoli.

  • Fractures can occur to the lateral malleoli on the outside of the medial malleoli on the inside.
  • It can sometimes be difficult to separate a fracture from a sprain, though feeling the ankle with the hands can sometimes indicate if it is a fracture or not.
  • An x-ray can show for sure if it is a fracture.

A dislocated ankle is a severe injury which usually happens in conjunction with a fracture or complete rupture of the lateral ankle ligaments.

Read more on ankle fractures & dislocations.

Osteochondral Lesions of the Talus

osteochondral lesions of the talus

Osteochondral lesions are fractures of the tough, smooth cartilage which protects the ends of bones.

  • The talus bone is located above the calcaneus (heel bone) and usually fractures in conjunction with an ankle sprain.
  • As a result, Osteochondral fractures are often diagnosed later, when the injury fails to heal.

Read more on Osteochondral lesions of the talus.

Ankle Avulsion Fracture

ankle avulsion fracture - acute injuries

An ankle avulsion fracture occurs when a tendon or ligament comes away from the bone often pulling a small piece of bone with it. Symptoms of an ankle avulsion fracture are very similar to a normal sprained ankle making it very difficult to tell the difference without an X-ray or MRI scan.

There will be a pain in the ankle immediately after the injury occurs with immediate swelling. Bruising may develop later and the athlete will most likely have difficulty moving or putting weight on the ankle. Although treatment is often the same whether there is an avulsion fracture or just a sprain, it may depend on the severity of the fracture and also its alignment. it is important children receive the correct treatment for a fracture as it could affect their long-term skeletal growth.

Read more on ankle avulsion fractures.

Immediate first aid for acute ankle injuries

Apply the PRICE principles for the first two to three days.

  • Protect – Prevent the ankle from suffering further damage. Stop training or playing immediately and apply cold therapy and a compression wrap. Where applicable, use ankle support or brace.
  • Rest – Refrain from exercise and try to reduce the demands of your daily activity to encourage recovery. It not only refers to the time that the athlete will be out of action but also to the immediate period after the injury. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
  • Ice – The application of ice or cold therapy to the area of the ankle injury/swelling can assist in reducing the symptoms of pain and inflammation.
  • Compression – The use of compression support or compression bandages to the ankle can help reduce swelling and offer support.
  • Elevation – Keeping the foot elevated above heart level whenever possible can help reduce swelling due to the effects of gravity.

Read more on PRICE principles.


  • Doherty C, Delahunt E, Caulfield B et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 2014;44(1):123–40.
  • Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports 1997;7(3):166–71
This article has been written with reference to the bibliography.
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