Ankle Sprain (ATFL Only)

Updated: Sep 29, 2019

Cause: Twisting injury

Appearance: Twisting injury with sudden pain and limp. Bruising and swelling, difficulty walking.

How to Diagnose: X-ray to rule out fracture/dislocation, clinical exam (anterior drawer and talar tilt test). MRI can help in grading severity of sprain.


- For Grade 1 (strain of the ligament with no tear)

o Rest, Ice, Elevation

o Brace /tape for 3 weeks

o Rest from tennis for 3 weeks if unable to bounce up and down/ run without pain

o Physical therapy

o Brace/tape with tennis for 3 weeks

- For Grade 2 (Partial tear of the ligament)

o Rest, ice, elevation

o Immobilization in boot for 4 weeks

o Physical therapy

o Transition from boot to brace for walking/ normal daily activity

o Return to tennis in 4-6 weeks

o Brace/tape with tennis for 4 weeks

- Grade 3 (complete tear of ligament)

o If 1st tear in athletes career

§ Rest, ice, elevation

§ Complete non-weightbearing in boot 4 weeks

§ Early physical therapy

§ 2 weeks transition to brace for walking

§ Return to tennis at 6 weeks if able- in brace/ tape

§ Brace/ tape for the remainder of athletes career

§ Potential primary surgical repair

o If athlete has already had a past grade 3 tear

§ Special consideration should be given to primary repair of the ligament

§ If not a surgical candidate

· Continue with treatment steps above

- We recommend augmentation with synthetic grafting for any repeat surgery.

Long-term prognosis: Typically, conservative care is successful if begun soon after injury and the athlete does not go back to activity too soon. Chronic instability can happen in athletes with weak ligaments or who do not rehab their injury fully.

Who to call: Podiatrist, orthopedic surgeon

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