Foot Sprain

Anatomy and Function of the Ankle and Foot

The ankle and foot are marvels of human anatomy, consisting of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments.1,2 This complex structure allows us to walk, run, jump, and dance, all while providing stability and support for our entire body weight.

Let's take a closer look at the main regions of the foot:

• The hindfoot includes the heel bone (calcaneus) and the ankle bone (talus)
• The midfoot includes the navicular, cuboid, and cuneiform bones, which form the arches of the foot
• The forefoot consists of five long metatarsal bones and the toes (phalanges)

Connecting these bones are a network of ligaments—tough bands of tissue that provide stability and prevent excessive motion. The most important ligaments in the ankle are the anterior talofibular ligament (ATFL) and the deltoid ligament, which help to stabilize the joint and prevent sprains.1,2

Tendons attach muscles to bones. The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone and allowing us to point our toes and push off the ground when walking or running.1,2

Common Types of Foot and Ankle Sprains

A sprain occurs when the ligaments that connect the bones in the foot or ankle are stretched or torn, usually due to a sudden twisting or rolling motion. Let's take a closer look at some of the most common types of foot and ankle sprains.

Ankle Sprains

The most common type of ankle sprain is an inversion sprain, which happens when the foot rolls inward. This over-stretches or tears the ligaments on the outside of the ankle.8,9 This type of sprain can range from mild (grade 1) to severe (grade 3), with symptoms like pain, swelling, bruising, and instability varying accordingly.13,14

Ankle sprains are incredibly common, with an estimated 3.1 million cases occurring annually in the United States alone.19 They are prevalent among athletes, with ankle sprains accounting for 15% of all injuries in collegiate sports.20 Risk factors for ankle sprains include a previous history of sprains, higher body mass index (BMI), and participation in high-risk sports like basketball, football, and volleyball.17,18

Midfoot Sprains

Midfoot sprains occur in the central region of the foot and are often caused by activities involving twisting or pivoting, like football, soccer, and dance.10,11 These sprains can affect the ligaments that connect the bones of the midfoot.

Symptoms of a midfoot sprain may include pain, swelling, and bruising in the middle of the foot, as well as difficulty bearing weight or walking. In severe cases, there may be a visible deformity or instability in the midfoot.

Turf Toe

Another type of foot sprain is "turf toe," which affects the joint at the base of the big toe (the metatarsophalangeal joint). This injury often occurs when the big toe is bent back too far, such as when pushing off to run or jump on a hard surface like artificial turf.7,12

Symptoms of turf toe may include pain, swelling, and stiffness in the big toe, as well as difficulty bearing weight or walking. In severe cases, there may be a popping sensation or visible bruising around the joint.

Symptoms and Diagnosis of Foot and Ankle Sprains

Foot and ankle sprains are incredibly common injuries. In this section, we'll explore the symptoms of foot and ankle sprains, as well as how to diagnose your foot injury.

Symptoms

The most common symptoms of a foot or ankle sprain include:

• Pain can range from mild to severe, depending on how bad the injury is. The pain is usually just in the area of the sprain and may worsen with movement or weight-bearing.
• Swelling in the affected area is the body’s natural response to the trauma. This swelling can range from mild-looking lump to a severe “blowing up” of the foot that may make it difficult to move the foot or ankle.
• Bruising or discoloration may occur, particularly if there is significant ligament damage or bleeding under the skin.
• Difficulty bearing weight: It may be painful or impossible to put weight on the injured foot or ankle. This can make it difficult to walk or perform other weight-bearing activities.
• Instability: Severe sprains can cause a feeling of instability or "giving way" in the injured joint, as the damaged ligaments are unable to provide the necessary support.

Diagnosis

If you’re not sure if you have a sprain or a bone fracture, it’s a good idea to see a healthcare provider. The diagnostic process typically involves the following steps:

1. Physical examination: A healthcare provider will carefully examine the injury, checking for tenderness, swelling, bruising, and instability. They may also assess the range of motion and strength of the joint.
2. Imaging tests: In some cases, imaging tests may be necessary to rule out fractures or other more serious injuries. X-rays can help to visualize the bones in the foot and ankle, while MRI or CT scans can provide more detailed images of the soft tissues, including ligaments and tendons.22,23

Causes and Risk Factors

Foot and ankle sprains often happen during activities that involve sudden changes in direction, jumping, or landing on an uneven surface. Sports like basketball, soccer, football, and volleyball are particularly high-risk, as they often involve these types of movements.30,31

However, sprains can also occur during everyday activities, such as walking on an uneven sidewalk or stepping off a curb awkwardly.

Several factors can increase your risk of a foot or ankle sprain, including:

• Previous sprains or ankle injuries, especially if you haven’t fully healed and strengthened the area44,47
• Poor physical conditioning or muscle weakness in the lower legs
• Inadequate or improper footwear for the activity
• Participating in high-risk sports or activities
• Abnormal foot structure or mechanics, such as high arches or flat feet
• Obesity or high body mass index (BMI)48,49

Treatment and Recovery for Foot and Ankle Sprains

When a sprain occurs, the first thing you will need to do is put ice on the injury.

It’s also important to elevate your injured foot and rest, meaning try not to put any weight on it.

These treatments can help reduce pain and swelling.42,43

Over-the-counter pain medications, such as ibuprofen or acetaminophen, can also help manage discomfort. However, more severe sprains may require additional interventions.

If the pain and bruising is severe, you should see a healthcare provider. They may tell you to immobilize the foot with a brace, walking boot or cast.41 In some cases, you may need crutches to keep weight off the injured foot.

In rare cases, surgery may be necessary to repair severely torn ligaments or address persistent instability that does not respond to conservative treatment.32,34 Surgical options may include ligament reconstruction or the use of internal fixation devices to stabilize the affected joint.

As you start to recover, you may need to do physical therapy to restore strength, flexibility, and range of motion to the injured area.30,33

This typically begins with gentle range-of-motion exercises and progressively advances to more challenging activities, such as balance and proprioceptive training.45,46 These exercises help to retrain the body's sense of position and movement, which can be impaired following a sprain. Gradually, you will be able to return to your normal activities. It’s really important to avoid returning too soon to prevent re-injury.

The recovery timeline for a foot or ankle sprain can vary widely depending on the severity of the injury and your overall health. Minor sprains may get better within a few weeks, while more severe injuries can take several months to fully heal.38,40

Preventing Future Foot and Ankle Injuries

One of the most important aspects of preventing foot and ankle sprains is maintaining proper conditioning and strength in the lower extremities.

• Exercises that target the muscles of the foot, ankle, and lower leg can help to improve stability and reduce the risk of injury.55,52 Examples include calf raises, toe curls, and balance training on unstable surfaces like a wobble board or foam pad.
• Proprioceptive training focuses on enhancing the body's ability to sense its position and movement in space.50,51 This teaches you to react more quickly and effectively to changes in terrain or sudden movements.
• Wear shoes that are appropriate for the specific activity and provide adequate support and stability.50,52 It's important to replace worn-out shoes regularly, as the loss of cushioning and support can increase the risk of injury over time.50
• If you’ve had a foot or ankle sprain, it’s important to take steps to prevent reinjuring yourself. You can use prophylactic bracing or taping for additional support and stability.50,52
• Allow enough time for healing and rehabilitation after a sprain. Rushing back to activity too soon can increase the risk of re-injury.50,51 Ask your doctor about a gradual return-to-activity plan.

Conclusion

Foot and ankle sprains are among the most common injuries in athletes and the general population. These injuries can range from mild stretches to severe tears of the ligaments that support and stabilize the foot and ankle complex. After you’re injured, use ice on the injury and keep it elevated to reduce swelling. Over-the-counter pain medications can be effective for minor sprains. You may need to immobilize the foot for more severe injuries. It can take a few weeks to six months to recover, depending on how severe the sprain is. Give yourself the time you need to heal. And make sure you have a plan to strengthen and condition the foot and ankle to reduce the risk of reinjuring yourself.

Citations:

<1>Orthopaedia. Anatomy of the foot and ankle.</1>

<2>Arthritis Foundation. Anatomy of the foot.</2>

<3>Sakamoto, K., Edama, M., Osanami, H., Yokota, H., Hirabayashi, R., Sekine, C., ... & Kageyama, I. (2022). Relationship between joint structure of the first tarsometatarsal joint and its degeneration. Foot & Ankle International, 43(5), 573-580.</3>

<4>Verleyen, M., He, Y., Burssens, A., Silva, M. S., Callewaert, B., & Audenaert, E. (2022). A systematic review and cross-database analysis of single nucleotide polymorphisms underlying hip morphology and osteoarthritis reveals shared mechanisms. Osteoarthritis and Cartilage, 30(5), 677-686.</4>

<5>Song, Y., Cen, X., Sun, D., Kovács, B., Wang, Y., Chen, H., ... & Gu, Y. (2022). Curved carbon-plated shoe may further reduce forefoot loads compared to flat plate during running. Journal of Biomechanics, 134, 111055.</5>

<6>Charmode, S., Mehra, S., & Mishra, A. K. (2022). Causal Relationships Between Physical Activity and Arthrokinematic Integrity of the Ankle Joint-Foot Complex Across Normal and Pathological Phenomena: A Case-Control Analysis. Indian Journal of Orthopaedics, 56(5), 1-7.</6>

<7>Bowers, K. D., & Martin, R. B. (1976). Turf-toe: a shoe-surface related football injury. Medicine and Science in Sports, 8(2), 81-83.</7>

<8>Bennett, H., Fuller, J., Debenedictis, T., & Chalmers, S. (2019). Ankle sprain, concussion, and anterior cruciate ligament injuries are common and burdensome in sub-elite female Australian football players. Physical Therapy in Sport, 35, 1-6.</8>

<9>Rhim, H. C., Afifi, T., Xu, R. F., Noble-Taylor, K., Gureck, A. E., Barrack, M. T., ... & Tenforde, A. S. (2021). Epidemiology of injuries in US high school track and field throwing events from 2008 to 2019. The American Journal of Sports Medicine, 49(10), 2707-2714.</9>

<10>Cheng, X., Li, J., Pei, M., Li, N., Hu, Y., Guo, Q., ... & Jiang, D. (2022). Medial cystic osteochondral lesions of the talus exhibited lower sports levels, higher cyst-presence rate, and inferior radiological outcomes compared with lateral lesions following arthroscopic bone marrow stimulation. The American Journal of Sports Medicine, 50(7), 1855-1863.</10>

<11>Pizzarro, J., Chiang, B., Malyavko, A., Monroig, C., Mehran, N., Ahmed, S. I., & Tabaie, S. (2021). Epidemiology of Sports Injuries Among High School Athletes in the United States: Data From 2015 to 2019. Orthopaedic Journal of Sports Medicine, 9(7), 23259671211024524.</11>

<12>Menezes-Reis, R., Beirigo, E. K., Maciel, T. D. S., de Souza Borges, N. C., de Santiago, H. A. R., & Leite, W. (2022). Functional capacity and risk of injury in CrossFit practitioners measured through smartphone apps. Revista Brasileira de Medicina do Esporte, 28(1), 1-5.</12>

<13>Sampsell, E. (2022). How Long Does It Take for a Sprained Ankle to Heal?. Healthline. https://www.healthline.com/health/how-long-does-it-take-for-a-sprained-ankle-to-heal</13>

<14>Cleveland Clinic. (2022). Sprained Ankle: Symptoms, Types, Treatment & Recovery. https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle</14>

<15>UCSF Health. (2022). Tips for Preventing Foot and Ankle Injuries. https://www.ucsfhealth.org/education/tips-for-preventing-foot-and-ankle-injuries</15>

<16>Henry Ford Health. (2020). 8 Simple Ways To Prevent Foot And Ankle Injuries. https://www.henryford.com/blog/2020/11/8-simple-ways-to-prevent-foot-and-ankle-injuries</16>

<17>Tyler, T. F., McHugh, M. P., Mirabella, M. R., Mullaney, M. J., & Nicholas, S. J. (2006). Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index. The American Journal of Sports Medicine, 34(3), 471-475.</17>

<18>Milgrom, C., Shlamkovitch, N., Finestone, A., Eldad, A., Laor, A., Danon, Y. L., ... & Simkin, A. (1991). Risk factors for lateral ankle sprain: a prospective study among military recruits. Foot & Ankle, 12(1), 26-30.</18>

<19>Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J., & Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Medicine, 44(1), 123-140.</19>

<20>Mauntel, T. C., Wikstrom, E. A., Roos, K. G., Djoko, A., Dompier, T. P., & Kerr, Z. Y. (2017). The epidemiology of high ankle sprains in National Collegiate Athletic Association sports. The American Journal of Sports Medicine, 45(9), 2156-2163.</20>

<21>Rhon, D. I., Fraser, J. J., Sorensen, J., Greenlee, T. A., Jain, T., & Cook, C. E. (2019). Delayed rehabilitation is associated with recurrence and higher medical care use after ankle sprain injuries in the United States military health system. Journal of Orthopaedic & Sports Physical Therapy, 49(6), 417-425.</21>

<22>Wu J, Wang Y, Wang Z. The diagnostic accuracy of ultrasound in the detection of foot and ankle fractures: a systematic review and meta-analysis. Medical Ultrasonography. 2021 May 20;23(2):203-12.</22>

<23>Fisher CL, Rabbani T, Johnson K, Reeves R, Wood A. Diagnostic capability of dynamic ultrasound evaluation of supination-external rotation ankle injuries: a cadaveric study. BMC musculoskeletal disorders. 2019 Dec;20(1):1-7.</23>

<24>Hosseinian SH, Aminzadeh B, Rezaeian A, Jarahi L, Naeini AK, Jangjui P. Diagnostic Value of Ultrasound in Ankle Sprain. The Journal of Foot and Ankle Surgery. 2021 Aug 20.</24>

<25>Koris, J., Calder, J. D. F., Dalmau-Pastor, M., Fernandez, M. A., & Ramasamy, A. (2022). Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments. Injury, 53(4), 1141-1148.</25>

<26>Dalmau-Pastor, M., Malagelada, F., Guelfi, M., Kerkhoffs, G., Karlsson, J., Calder, J., & Vega, J. (2016). The deltoid ligament is constantly formed by four fascicles reaching the navicular, spring ligament complex, calcaneus and talus. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), 1086-1093.</26>

<27>Alayat, M. S., Takaroni, A., Elsodany, A. M., AlMatrafi, N. A., Subahi, M. S., & Battecha, K. H. (2023). Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis. Lasers in Medical Science, 38(2), 1-10.</27>

<28>Jiang, H., Xue, X., Wang, J., Gao, Y., & Li, X. (2022). [Effectiveness of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the 5th metatarsal base]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 36(5), 573-578.</28>

<29>Alayat, M. S., Takaroni, A., Elsodany, A. M., AlMatrafi, N. A., Subahi, M. S., & Battecha, K. H. (2024). Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis. Lasers in Medical Science, 39(1), 116. https://doi.org/10.1007/s10103-024-04063-6</29>

<30>Terada M, Pietrosimone BG, Gribble PA. Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review. J Athl Train. 2013;48(5):696-709. doi:10.4085/1062-6050-48.4.11</30>

<31>Meyer SA, Callaghan JJ, Albright JP, et al.: Midfoot sprains in collegiate football players.</31>

<32>Broström L. Sprained ankles, VI: surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 1966;243:551–565.</32>

<33>Thacker S B, Stroup D F, Branche C M, Gilchrist J, Goodman R A, Weitman E A. The prevention of ankle sprains in sports: a systematic review of the literature. Am J Sports Med. 1999;27:753–760.</33>

<34>Brostrom L. Sprained ankles, VI: surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 1966;132(5):551–565.</34>

<35>Chen, Z., Zhao, Y., Xue, X., Gu, X., Li, Y., & Hua, Y. (2022). Predictive Modeling for Functional Outcomes After All-Inside Arthroscopic Anterior Talofibular Ligament Repair of Chronic Ankle Instability. The American Journal of Sports Medicine, 50(12), 3301-3310. doi:10.1177/03635465221116326</35>

<36>Dalmau-Pastor, M., Malagelada, F., Guelfi, M., Kerkhoffs, G., Karlsson, J., Calder, J., & Vega, J. (2020). The deltoid ligament is constantly formed by four fascicles reaching the navicular, spring ligament complex, calcaneus and talus. Knee Surgery, Sports Traumatology, Arthroscopy, 28(5), 1470-1477. doi:10.1007/s00167-019-05678-x</36>

<37>Wang, C., Dong, S., Li, X., Ma, J., Wang, W., & Ling, Z. (2022). Maisonneuve fracture treated with short leg cast: A case report with 41-month follow-up. Journal of Orthopaedic Surgery and Research, 17(1), 1-6. doi:10.1186/s13018-022-03181-6</37>

<38>Sandow, E. (2022). How Long Does It Take for a Sprained Ankle to Heal?. Healthline. Retrieved from https://www.healthline.com/health/how-long-does-it-take-for-a-sprained-ankle-to-heal</38>

<39>Cleveland Clinic. (2022). Sprained Ankle: Symptoms, Types, Treatment & Recovery. Retrieved from https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle</39>

<40>Frankel Foot & Ankle Center. (2022). Ankle Sprain Recovery Time - The Frankel Foot & Ankle Center. Retrieved from https://frankelfoot.com/blog/foot-ankle-health/ankle-sprain-recovery-time/</40>

<41>Mass General Brigham. (2022). Sprained Ankle: Treatment & Symptoms | Mass General Brigham. Retrieved from https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/foot-ankle/ankle-sprain</41>

<42>Harvard Health Publishing. (2022). Recovering from an ankle sprain - Harvard Health. Retrieved from https://www.health.harvard.edu/pain/recovering-from-an-ankle-sprain</42>

<43>Mayo Clinic Health System. (2022). Ankle sprain treatment & recovery - Mayo Clinic Health System. Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/sprained-your-ankle-now-what</43>

<44>Ankle and Foot Specialist. (2022). A Close View at the Long-Term Effects of Ankle Sprains - Ankle and Foot Specialist. Retrieved from https://ankleandfootspecialist.com/a-close-view-at-the-long-term-effects-of-ankle-sprains/</44>

<45>Wagemans, P. H., Kerkhoffs, G. M., Verhagen, E. A., & van Dijk, C. N. (2022). Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PloS one, 17(1), e0262023. https://doi.org/10.1371/journal.pone.0262023</45>

<46>Bleakley, C. M., O'Connor, S. R., Tully, M. A., Rocke, L. G., Macauley, D. C., Bradbury, I., ... & McDonough, S. M. (2010). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj, 340.</46>

<47>Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: a literature review. J Athl Train. 2002;37(4):376-380.</47>

<48>Pourgharib Shahi MH, Selk Ghaffari M, Mansournia MA, Halabchi F. Risk Factors Influencing the Incidence of Ankle Sprain Among Elite Football and Basketball Players: A Prospective Study. Foot Ankle Spec. 2020:1938640020921251.</48>

<49>Tyler TF, McHugh MP, Mirabella MR, Mullaney MJ, Nicholas SJ. Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index. Am J Sports Med. 2006;34(3):471-475. doi:10.1177/0363546505280429</49>

<50>Eller, E. (2020). 8 Simple Ways To Prevent Foot And Ankle Injuries | Henry Ford Health - Detroit, MI. Henry Ford Health. https://www.henryford.com/blog/2020/11/8-simple-ways-to-prevent-foot-and-ankle-injuries</50>

<51>Hupperets, M. D., Verhagen, E. A., & van Mechelen, W. (2009). Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 339, b2684.</51>

<52>Kawabata, S., Murata, K., Iijima, H., Nakao, K., Kawabata, R., Terada, H., ... & Kanemura, N. (2023). Foot (Edinb), 54, 101963.</52>

<53>Derry, C. R., Menz, H. B., Kryger, K. O., Thomson, A., Hoey, C., & Bonanno, D. R. (2023). Factors that influence field hockey footwear selection: An online survey. Journal of Science and Medicine in Sport, 26(3), 232-237.</53>

<54>Rausch, L., Limmer, M., Pocecco, E., Ruedl, G., Posch, M., & Faulhaber, M. (2023). Sex-specific analysis of hiking accidents in the Austrian Alps: a follow-up from 2015 to 2021. BMJ Open Sport & Exercise Medicine, 9(1), e001424.</54>

<55>Leppänen, M., Viiala, J., Kaikkonen, P., Tokola, K., Vasankari, T., Nigg, B. M., Krosshaug, T., Werthner, P., Parkkari, J., & Pasanen, K. (2023). Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT). British Journal of Sports Medicine, 57(5), 276-282.</55>

<56>Fousekis, K., Tsepis, E., & Vagenas, G. (2012). Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players. The American Journal of Sports Medicine, 40(8), 1842-1845.</56>

<57>Hubbard, T. J., Kramer, L. C., Denegar, C. R., & Hertel, J. (2007). Contributing factors to chronic ankle instability. Foot & Ankle International, 28(3), 343-354.</57>

<58>Malliou, P., Gioftsidou, A., Pafis, G., Beneka, A., & Godolias, G. (2004). Proprioceptive training (balance exercises) reduces lower extremity injuries in young soccer players. Journal of Back and Musculoskeletal Rehabilitation, 17(3-4), 101-104.</58>