Is it a sprain or a fracture?

The Ottawa Ankle Rules are the standard screening tool to decide if X-rays are needed. Imaging is warranted if you have bony tenderness over the posterior edge or tip of either malleolus, tenderness at the navicular or base of the 5th metatarsal, or an inability to bear weight for 4 steps both immediately and in the clinic. The rules have sensitivity close to 100 percent for clinically significant fractures. If any of those criteria are present, I refer for imaging before loading the ankle.

Should I keep walking on a sprained ankle?

For most grade 1 and grade 2 lateral sprains, yes, within pain tolerance. The PEACE and LOVE framework (Dubois and Esculier, BJSM 2020) has replaced strict RICE. Early protected weight bearing and gradual loading improve outcomes compared to prolonged immobilization. The JOSPT clinical practice guideline (Martin et al., 2021) supports early functional rehabilitation. If you cannot bear weight at all or have a clear fracture pattern, that is different and needs screening first.

How long does a sprained ankle take to heal?

Grade 1 sprains typically recover in 1 to 3 weeks, grade 2 in 3 to 6 weeks, and grade 3 in 6 to 12 weeks for baseline function. Tissue remodelling continues for 6 to 12 months. Tassignon et al. identified pain with weight-bearing dorsiflexion and restricted range of motion at 4 weeks as predictors of slower recovery. Feeling normal is not the same as being fully rehabilitated, which is why reinjury is common when people stop at symptom resolution.

Why does my ankle still feel weak months after I sprained it?

Roughly 40 percent of people who sustain a first-time lateral ankle sprain go on to develop chronic ankle instability at 12 month follow-up (Doherty et al., AJSM 2016). This is not just ligament laxity. It involves damaged mechanoreceptors, altered peroneal muscle timing, and compensatory strategies that ripple up the hip and trunk. The fix is targeted balance and neuromuscular training, strength work for the peroneals and hip, and progressive loading of sport-specific tasks, not more rest.

Do I need an MRI for a sprained ankle?

Usually no. Most lateral ankle sprains are diagnosed clinically and do not require MRI. I consider advanced imaging when symptoms are not improving as expected at 6 to 8 weeks, when there is suspicion of a syndesmotic (high ankle) injury, osteochondral lesion of the talus, peroneal tendon tear, or when mechanical symptoms like locking or catching persist. X-rays per Ottawa Ankle Rules are the appropriate first imaging step if indicated acutely.

When can I return to sport after an ankle sprain?

Return to sport is criterion-based, not time-based. I use objective markers from the JOSPT CPG (Martin et al., 2021), including pain-free hopping and cutting, symmetrical single-leg balance (Star Excursion or Y-Balance within 4 cm of the other side), ankle strength within about 90 percent of the uninjured side, and completion of progressive agility and sport-specific drills without apprehension. Depending on grade, this is typically 2 to 8 weeks for simple sprains and longer for grade 3 or high ankle sprains.

Ankle Sprains Treatment in Burlington | Kareem Hassanein Physiotherapy

Ankle Sprains

Lateral and medial ligament injuries, chronic ankle instability

Treating ankle sprains at my Burlington clinic. Convenient for Waterdown and Flamborough residents.

Important: When to seek immediate medical attention

Inability to bear weight (4 steps)

X-ray per Ottawa ankle rules

Numbness or color changes

Assessment for nerve or vascular injury

Pathophysiology and contributing factors.

Inside Overview

The Science of Ankle Sprains

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Ankle sprains involve stretching or tearing of ligaments, usually the lateral ligaments (ATFL, CFL). This damages mechanoreceptors, affecting proprioception. The condition represents a complex injury that affects both structural integrity and neurological function. Lateral ankle sprains occur when the foot rolls inward (inversion), placing excessive stress on the outer ankle ligaments. The anterior talofibular ligament (ATFL) is typically injured first, followed by the calcaneofibular ligament (CFL) in more severe cases. The injury disrupts the mechanoreceptors within the ligament tissue, which normally provide critical position and movement feedback to the brain. Without proper rehabilitation, 30-70% of individuals develop chronic ankle instability (CAI), characterized by persistent symptoms of pain, swelling, perceived instability, and recurrent sprains for at least one year after the initial injury. This progression is not simply due to structural damage but involves complex changes in neuromuscular control and movement patterns throughout the entire lower extremity.

Ankle Sprains

The Science of Ankle Sprains

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