Ankle Sprains:
Anatomy, Risk Factors, and Prevention

Ankle sprains are one of the most common injuries affecting both athletes and non-athletes. They occur when the ankle is suddenly inversing, leading to possible damage to the ligaments that connect the tibia and fibula with the bones of the foot. While ankle sprains are often seen as minor injuries, they can cause significant pain and discomfort, and if left untreated, they can result in chronic ankle instability. In this article, we will explore the anatomy of the ankle, how ankle sprains happen, the risk factors associated with ankle sprains, and the preventative measures that can help reduce the risk of an ankle sprain.

The ankle is a complex joint made up of three bones: the tibia, fibula, and talus. The tibia is the larger of the two bones in the lower leg and connects to the ankle on the medial (inner) side. The fibula is the thinner of the two bones in the lower leg and connects to the ankle on the lateral (outer) side. The talus is a small bone located between the heel bone (calcaneus) and the tibia and fibula. Together, tibia, fibula, and talus make up the ankle joint.

The ankle joint is stabilized by a group of ligaments that help to hold the bones in place. These ligaments include the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The ATFL and CFL are the most commonly injured ligaments in an ankle sprain.

The ankle joint allows for dorsiflexion (bending the foot towards the shin), plantarflexion (pointing the foot away from the shin), inversion (turning the foot inward), and eversion (turning the foot outward). The ankle joint works in conjunction with the foot and the lower leg to provide stability and movement during weight-bearing activities such as walking, running, and jumping.

What Happens in an Ankle Sprain?

An ankle sprain happens when the ligaments of the ankle are stretched beyond their normal range of motion. This can happen in a variety of ways, such as landing on the ankle after a jump, or twisting the ankle on an uneven surface. A Sports Medicine review showed that three quarter of ankle sprains occur on the lateral side and that more than 50 per cent affect the anterior talofibular ligament. When the ligaments are stretched too far, they can become torn, leading to pain, swelling, bruising, and loss of function. Depending on the severity of the sprain, the ankle may feel unstable, and it may be difficult to put weight on the foot.

Risk Factors for Ankle Sprain

Ankle sprains are a common injury that can occur when the ligaments connecting the bones in the ankle are stretched or torn. While ankle sprains can happen to anyone, there are certain factors that can increase the risk of experiencing this injury. Here are 5 risk factors for ankle sprain and how each factor increases the risk.

1. Previous Ankle Injuries

One of the biggest risk factors for ankle sprain is a previous ankle injury. If you have sprained your ankle in the past, you are more likely to do so again. This is because the ligaments in the ankle may have been weakened or stretched out from the previous injury, making them more vulnerable to damage in the future.

2. Lack of Flexibility

Another risk factor for ankle sprain is a lack of flexibility in the ankle and surrounding muscles. If your ankle and calf muscles are tight, you may have limited range of motion in the ankle, which can make it more difficult to maintain balance and stability. This can increase the risk of rolling or twisting the ankle, leading to a sprain.

3. Weak Ankles and Muscles

Weak ankles and muscles can also increase the risk of ankle sprain. If the muscles in your foot, lower leg, thigh, and core are not strong enough to support your body weight, your ankle may be more likely to give out or twist during physical activity. Weak ankles may be more prone to rolling or twisting, making them more vulnerable to sprains.

4. High Impact Sports

Participating in high-impact sports and activities, such as basketball or soccer, can also increase the risk of ankle sprain. These activities involve a lot of running, jumping, and sudden changes in direction, which can put a lot of stress on the ankle and increase the likelihood of injury.

5. Poor Footwear

Finally, wearing inappropriate or poorly fitting footwear can also increase the risk of ankle sprain. Shoes that are too loose or too tight can affect your balance and stability, while shoes with inadequate support or traction can make it more difficult to maintain proper foot placement and increase the risk of slipping or twisting the ankle.

Prevention Measures to Reduce Risk for Ankle Sprain

Ankle sprains are one of the most common injuries, especially among athletes and people who engage in physical activities. They occur when the ligaments that hold the ankle bones together are stretched or torn, causing pain, swelling, and limited mobility. Following, here are effective ways to prevent ankle sprains from happening.

Strengthening Exercises

One of the most effective ways to prevent ankle sprains is by strengthening the muscles and tendons around the ankle. The exercises that target these areas can improve stability and support of the ankle, reducing the risk of injuries. Examples of strengthening exercises include calf raises, toe raises, squats, lunges, or deadlifts.

Proper Jumping and Landing Technique

Using proper technique when engaging in physical activities or sports can also reduce the risk of ankle sprains. For instance, in basketball or volleyball, jumping and landing with a bent knee and keeping the ankle in a neutral position can reduce the risk of ankle injuries.

Warm-up and Stretch

Before engaging in physical activities or sports, it's important to warm up and stretch properly. Warming up can increase blood flow to the muscles, preparing them for the upcoming activity, and making them less prone to injuries. Stretching can also improve flexibility and range of motion, reducing the risk of muscle strains and sprains.

Maintain a Healthy Body Weight

Maintaining a healthy body weight is important for preventing ACL tears. Excess weight can place additional stress on the knee joint, increasing the risk of injury. Maintaining a healthy weight through regular exercise and a balanced diet can help to reduce this stress and improve overall joint health.

Wear Appropriate Footwear

Wearing appropriate footwear is also important for preventing ACL tears. Shoes with good shock absorption and lateral support can help to reduce the stress placed on the knee joint during activity. Additionally, shoes with good traction can help to prevent slips and falls, which can also increase the risk of an ACL tear.

Top Exercises to Prevent Ankle Sprain

Ankle sprains can be painful and disruptive, but they can be prevented by taking the necessary precautions. Strengthening exercises, proper footwear, warm-up and stretching, using proper technique, and avoiding high-risk activities are effective ways to reduce the risk of ankle sprains. By following these measures, you can enjoy physical activities and sports without the worry of getting injured. There are exercises you can do to strengthen the muscles that support your ankles and reduce your risk of injury. Here are 5.

If you feel discomfort or pain consult a medical professional and do NOT exercise!

1. Calf Raises

Stand tall with your feet hip-width apart, holding onto a stable surface for support if needed. Rise up onto the balls of your feet, lifting your heels as high as possible, and then slowly lower them back down. Perform 15-20 repetitions.

Calf raises strengthen the calf muscles, including the gastrocnemius and soleus. Strong calf muscles provide stability to the ankle joint, improving its ability to withstand sudden movements and reducing the risk of ankle sprains.

2. Toe Raises

Sit on a chair with your feet flat on the floor. Lift your toes as high as possible while keeping your heels on the ground, then lower them back down. Perform 15-20 repetitions.

Toe raises target the muscles in the front of the lower leg, known as the anterior tibialis. Strengthening these muscles helps maintain proper foot and ankle alignment, reducing the likelihood of rolling or twisting the ankle and preventing ankle sprains.

3. Squats

Stand with your feet shoulder-width apart, toes slightly turned out. Engage your core and lower your body by bending at the knees and hips, as if sitting back into a chair. Keep your heels on the ground and your knees aligned with your toes. Rise back up to the starting position. Perform 10-15 repetitions.

Squats are not only great for lower body strength but also for ankle stability. They target the muscles surrounding the ankle joint, including the calves, quadriceps, and glutes. Strengthening these muscles improves overall ankle stability, reducing the risk of ankle sprains during activities that require changes in direction or sudden stops.

4. Lunges

Stand with your feet hip-width apart. Take a step forward with one foot, lowering your body by bending both knees until the back knee is just above the ground. Push through the heel of your front foot to return to the starting position. Repeat on the other leg. Perform 10-12 lunges on each leg.

Lunges work multiple muscle groups, including the calves, quadriceps, hamstrings, and glutes. By targeting these muscles, lunges help improve lower body strength and stability, enhancing ankle control and reducing the risk of ankle sprains during dynamic movements.

5. Lateral Leg Raises

Stand tall with your feet together and your hands on your hips, or you can use a wall or chair for support. Lift one leg out to the side, keeping it straight or slightly bent at the knee, and then lower it back down in a controlled manner. Perform 12-15 repetitions on each leg.

Lateral leg raises target the hip abductor muscles, including the gluteus medius. These muscles play a crucial role in maintaining proper lower limb alignment and stability. Strengthening the hip abductors helps prevent inward collapsing of the ankle, reducing the risk of ankle sprains during activities involving lateral movements and changes in direction.