Ankle Sprain

Classic Inversion Strain is the most often presented ankle issue in clinic.

The main things to watch for are ‘extras’ like a fibula fracture.

There has been much research into this subject and the Ottowa Rules are used to determine severity and action:

Ankle X-Ray not needed if both are true:

  1. Able to walk at injury or in A & E for 4 steps
  2. No pain over distal posterior 6 cm of tibia, fibula

Foot X-ray not needed for Mid-Foot Pain if both true:

  1. Able to walk at injury or in A & E for 4 steps
  2. No pain at fifth Metatarsal base (outside of foot) and Tarsal Navicular (midfoot)

When we assess the ankle we test for  ligament and tendon pain and patency.

If there is laxity then there is good evidence the best recovery follows completely off loading and placing in a boot for a couple of weeks to give the ligament the opportunity to heal.

Early immobilisation pays big dividends as long as this is followed by good rehabilitation to restore functional range, strength and control. This is where Physiotherapy excels.


The demands of the sport have to be considered and rehabilitation should be sport specific. This type of sports rehabilitation is essential and should include exercises and drills that take you right back to the demands of your sport.

Recurrent strain
Repeated lateral ankle sprain is due to poor rehabilitation, weakness around the ankle and reduced proprioception or control. Physiotherapy is essential in restoring proper function.

Further Information & Case Studies