Lateral Ankle Sprain (Rolled or Twisted Ankle): What It Is, How It Happens, and How Physio Helps You Recover

Lateral ankle sprains are one of the most common injuries seen in physiotherapy clinics. Whether you rolled your ankle during sport, stepped off a curb awkwardly, or landed badly during a jump, the outside of the ankle is particularly vulnerable.

Although many people brush it off as “just a rolled ankle,” these sprains can heal poorly without the right rehab, increasing the risk of long-term instability.

What Is a Lateral Ankle Sprain?

A lateral ankle sprain is an injury to the ligaments on the outside of the ankle, usually caused by the foot twisting inward.

Most commonly affected ligaments are the anterior talofibular ligament (ATFL), followed by the calcaneofibular ligament (CFL) and, less often, the posterior talofibular ligament (PTFL).

These ligaments stabilise the ankle during walking, running and cutting movements. When they are overstretched or torn, the ankle becomes painful, swollen, and often unstable.

How Do Lateral Ankle Sprains Happen?

Most lateral ankle sprains occur through a combination of plantarflexion and inversion, essentially pointing the foot down and rolling it in. Common causes include:

• Sporting injuries (netball, soccer, basketball, AFL – especially during landing or direction changes)

• Uneven ground or sudden missteps

• Landing awkwardly from a jump

• Previous ankle sprains, which reduce proprioception and stability

• Wearing unsupportive footwear

• Fatigue leading to slower neuromuscular reactions

Common Signs and Symptoms

Symptoms can vary by severity, but typically include:

1. Pain on the outside of the ankle

Especially over the ATFL and CFL regions

2. Swelling & Bruising

Usually develops quickly within hours

3. Difficulty Weight Bearing

Depending on ligament damage and irritability

4. Feeling of Instability

Described as the ankle “giving way,” particularly on uneven surfaces

5. Reduced Range of Motion

Particularly dorsiflexion due to swelling and irritation

6. Tenderness on Palpation

Localised over lateral ligaments

From a clinical standpoint, lateral ankle sprains are graded:

• Grade I: Mild stretch, minimal swelling, walk with slight difficulty

• Grade II: Partial tear, moderate swelling and bruising, painful weight bearing

• Grade III: Complete ligament rupture, significant swelling, instability, often unable to walk without limping

Physiotherapy Treatment for Lateral Ankle Sprains

The right physio rehab is crucial for reducing pain, restoring strength, and preventing recurrent sprains. Treatment often includes:

1. Acute Phase (0–5 days)

Focus: Reduce pain and swelling

• RICE principles (rest, ice, compression, elevation)

• Load modification – not necessarily complete rest

• Gentle range-of-motion exercises

• Taping or bracing for support

• Manual therapy to improve joint mobility (e.g., talocrural joint)

2. Subacute Phase (5–21 days)

Focus: Restore mobility, strength, balance

• Calf and peroneal strengthening

• Resistance band inversion/eversion work

• Weight-bearing balance drills

• Gait retraining

• Propioception

• Progression to functional movements

3. Functional Rehab Phase (3–8 weeks)

Focus: Dynamic control and return to sport

• Plyometrics (hopping, bounding, jumping)

• Proprioception

• Agility and change-of-direction drills

• Sport-specific exercises

• Higher-level balance and proprioception training

  
  

Rehab must be progressive. Returning too early greatly increases the chance of reinjury.

Differential Diagnosis: Conditions That Mimic a Lateral Ankle Sprain

Not all “rolled ankles” are straightforward ligament sprains. A physio must screen for other pathologies, including:

1. Fractures

• 5th metatarsal base fracture

• Lateral malleolus fracture

• Talar dome lesion (osteochondral lesion)

  
  

2. Syndesmotic (High Ankle) Sprain

Injury to the anterior inferior tibiofibular ligament (AITFL). Often more painful and longer recovery

3. Peroneal Tendon Injury

Tendon irritation or subluxation can occur with the same mechanism

4. Lisfranc Injury

Midfoot injury often misdiagnosed as a simple sprain

5. Sinus Tarsi Syndrome

Chronic instability-related pain in the lateral ankle

6. ATFL/CFL Avulsion

Ligament pulling off a small piece of bone

This is why proper assessment and imaging guidelines, such as the Ottawa Ankle Rules, may be used to rule out fractures.

A lateral ankle sprain may seem minor, but without proper management, it can lead to lingering instability, weakness, or recurrent injuries. Early assessment, structured physiotherapy, and gradual return to activity are key.

If you're dealing with a rolled ankle, ongoing ankle pain, or repeated sprains, booking with a physio is the best next step.