Ankle Sprains And Ankle Instability

Ankles sprains are among the most common musculoskeletal injuries, with an estimated three million plus occurring in the United States each year. Although sprains are a common athletic injury, they can happen to anyone. Ankle instability often lingers after an ankle injury, which can predispose a person to future sprains and injuries.

Ankle Anatomy and Types of Ankle Sprains

Three bones meet at the juncture of the foot and leg to form the ankle joint, including the tibia and fibula of the lower leg, and the talus of the foot. Strong bands of ligaments hold the bones in place, supported by the muscles of the foot and ankle.

An ankle sprain is damage to one or more of the ligaments that provide support and stability to the foot-ankle complex. There are fundamentally three grades of ankle sprains:

First Degree Sprain: This occurs when the ligaments are stretched but not torn. You may experience mild pain or swelling, and running or jumping may be painful.
Second Degree Sprain: The most common type of ankle injury, a second degree sprain is a partial tearing of a ligament. Symptoms are swelling, bruising, pain and difficulty walking.
Third Degree Sprain: This is a severe injury where a ligament is completely torn, marked by severe pain and swelling and extreme loss of motion. Walking may be painful to impossible.


Other types of ankle injuries include strains, which cause damage to muscles or tendons, and bone fractures. Accurate diagnosis is vital to determining the best course of treatment for an ankle injury.

Causes of Ankle Sprains

An ankle sprain occurs when the joint is forcibly moved or twisted beyond its normal range of motion. Common causes of ankle sprains include:

  • Injury during sports
  • Improper landing from a jump
  • Tripping and falling
  • Walking or running on uneven surfaces that cause the ankle to roll
  • Losing balance while wearing high heels
  • Weak unstable ankles that are vulnerable to sprains
  • Previous ankle injuries that lead to instability

Symptoms of Ankle Sprains

Sprains and fractures have similar symptoms, and fractures are sometimes misdiagnosed as sprains. Symptoms include pain, swelling, bruising and inability to bear weight on the affected foot. The degree of pain is dependent on the severity of the sprain. If you suspect a sprain or fracture, you should seek medical attention immediately.

Ankle Sprain Diagnosis

During diagnosis, you will be asked to provide a medical history and given a clinical exam of the foot, knee and ankle. Imaging by X-ray, MRI or ultrasound may be prescribed to confirm diagnosis and rule out fracture.

At NYDNR, we use real-time diagnostic ultrasound to view the structures of the foot, ankle and knee, at rest and in motion, to gain a clear picture of the extent and severity of damage. Ultrasound is superior to X-ray or MRI due to its high resolution, the ability to view structures in motion, and the ability to obtain immediate results.

Dynamic ultrasound can be performed on site or in the clinic, immediately after an injury occurs, and there is no harmful radiation, so it can safely be used on anyone. We can also obtain images of the non-injured limb in the same session to make comparisons. Ultrasound can also help us track the rate and degree of healing and recovery during rehabilitation.


The Importance of Rehabilitation

After an ankle injury, it is extremely important to restore the strength and function of the foot-ankle complex. Failure to do so can predispose you to future injuries, and keep you from fully participating in your favorite physical activities. Without rehab, the tissues may heal, but the ankle may be left in a weakened and dysfunctional state.

In addition to the risk of instability, failure to fully rehabilitate your ankle can have far-reaching repercussions for physical performance. Your feet and ankles contain large numbers of proprioceptors that send important messages to the brain about your body’s position relative to gravity. After a traumatic injury, sensory information may be impaired, impeding activation of the leg muscles and disrupting balance. Poor balance at the foot-ankle complex can cause instability all the way along the kinetic chain and up the spine. This in turn can lead to a variety of pain syndromes throughout the body.

A proper rehabilitation program can restore ankle strength and stability, reducing your risk of pain, falls and re-injury in the future.

Ankle Injury Treatment

Whether your injury is a strain, sprain or fracture, rehabilitation is crucial to restoring full function. The treatment protocol is dependent on the specific nature of the injury. After diagnosis, a progressive treatment plan will be designed that will evolve as your injury heals and you begin to regain function.

A fracture will be immobilized in a cast for around six weeks, after which time you should receive physical therapy to regain full use of the injured limb. Treatment for a sprain will depend on whether it is a first, second or third degree injury. Early treatment requires rest, ice, compression and elevation, followed by gradual weight bearing and mobility exercises to strengthen and stretch the ankle.

Rehabilitation for a moderate sprain often takes from 8 to 10 weeks, focusing on strength, range of motion, proprioception and balance.

Ankle Injury Treatment at NYDNR

The foot and ankle specialists at NYDNR have the advantages of our full gait and motion analysis lab at their disposal, enabling them to use advanced technology for diagnosis and treatment of ankle injuries. This technology enables us to assess and track not only the injured joint, but its effect on the entire musculoskeletal system with accurate precision.

Our clinic has developed its own unique protocols for treating ankle instability and ankle sprains, to ensure fully restored function of the foot-ankle complex and optimal movement mechanics throughout the entire body.

Learn more about our latest technology for ankle rehabilitation and our award-winning evidence-based test for ankle stability.


Range of Available Unique Physical Therapy Treatments at Nydnrehab

Ankle Symposium

I have been a fan of this guy for years and he finally gave his first lecture in English, in London. Dr.Carles Pedret is a world-class medical consultant for muscle injuries in soccer players, tennis players and Olympic sprinters. He is called upon by EPl, Ligue One and LaLiga teams to asses when elite athletes like Messi , Ronaldo or Bale can safely return to the playing field after injury. Dr. Pedret reminds us that the most brilliant people are often the humblest. It was a great experience learning to combine MRI , ultrasonography and advanced functional technology to estimate and provide optimal treatment.


Treatment of Available Unique Physical Therapy Treatments at Nydnrehab


Our Awards

Clinical Case Studies

Case Study: Demystifying Persistent Ankle Pain

Our patient is a 44 year-old female complaining of ankle pain. She had sprained the ankle two years prior and had been successfully treated with physical therapy.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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