Medial Ankle Sprain: What It Is, Why It Happens, and How Physio Helps You Recover

Medial ankle sprains don’t get talked about as often as the classic rolled ankle, but when they happen, they can be stubborn, painful, and slow to settle. If you’ve felt pain on the inside of your ankle, struggled to walk normally, or noticed swelling around the bony bump (the medial malleolus), there’s a good chance the deltoid ligament is involved.

As physiotherapists, we commonly see medial ankle sprains in runners, field athletes, and everyday people who simply stepped awkwardly.

What Is a Medial Ankle Sprain?

A medial ankle sprain involves injury to the deltoid ligament complex, a strong fan-shaped ligament that sits on the inside of the ankle. Unlike the lateral ligaments (commonly sprained when you “roll” your ankle outward), the deltoid ligament stabilises the ankle against eversion; when the foot rolls outward and the ankle collapses inward.

Because the deltoid ligament is thick and strong, it takes a higher-force mechanism to injure it. That makes medial ankle sprains less common, but often more serious.

How Do People Get a Medial Ankle Sprain?

A medial ankle sprain typically happens when the foot is forced into eversion with either rotation or impact. Common mechanisms include:

• Landing on uneven ground and the ankle collapsing inward

• Sudden change of direction in sports like soccer, AFL, basketball

• Direct trauma to the lateral side of the ankle, pushing it inward

• High-impact forces such as jumping or tackling

• Overpronation during running (longer-term overload of the medial structures)

  
  

In non-athletes, it often happens during simple daily activities, missing a step, slipping off a curb, or twisting awkwardly while walking.

Common Signs and Symptoms

Inside-ankle injuries produce a clear pattern of symptoms:

• Pain on the inner side of the ankle (around the medial malleolus)

• Swelling or bruising medially

• Difficulty bearing weight or pushing off

• Feeling of instability, especially on uneven surfaces

• Pain when turning the foot outward or when the physio applies eversion stress

• Stiffness in the ankle joint the morning after injury

  
  

If the pain is sharp, weight-bearing is difficult, or swelling is significant, physiotherapy assessment is important because medial ankle sprains often occur with associated injuries.

How Physiotherapists Diagnose a Medial Ankle Sprain

A thorough physio assessment will include:

• Palpation of the deltoid ligament

• Eversion stress tests

• Checking for ligament laxity

• Assessment of tibial and fibular movement

• Gait and load assessment

• Range of motion testing

• Review for possible associated injuries like tendon involvement or fractures

  
  

Medical imaging (X-ray, ultrasound or MRI) may be recommended if the mechanism was high-force, if bruising is extensive, or if weight-bearing is difficult.

Physiotherapy Treatment for Medial Ankle Sprains

Physio treatment focuses on restoring mobility, strength, stability, and movement control.

Because the deltoid ligament is a major stabiliser, rehab needs to be structured and progressive.

Early-Stage Management

• Protecting the ligament with taping or bracing

• Reducing swelling with compression and elevation

• Gentle pain-free range-of-motion exercises

• Isometric strengthening of surrounding muscles

• Gradual weight-bearing as tolerated

  
  

Mid-Stage Rehabilitation

• Targeted strengthening of the posterior tibialis, peroneals, calf complex

• Mobility work to restore dorsiflexion

• Balance and proprioception training

• Controlled single-leg loading

  
  

Late-Stage Return-to-Sport Rehab

• Plyometrics

• Directional change drills

• Running progressions

• Sport-specific agility retraining

• Reintroducing cutting, pivoting, and acceleration work

  
  

Physiotherapists also address contributing factors such as overpronation, foot strength deficits, and running biomechanics.

Differential Diagnosis: What Else Could It Be?

Medial ankle pain isn’t always a deltoid ligament sprain. Physiotherapists must rule out several other conditions:

1. Posterior Tibialis Tendinopathy

• Pain slightly behind/below the medial malleolus

• Worse with walking or running

• Often linked to overpronation or arch fatigue

  
  

2. Medial Malleolus Stress Fracture

• More focal, sharp pain

• Pain increases with impact, improves with rest

• High on the list for runners

  
  

3. Tarsal Tunnel Syndrome

• Burning, tingling, or nerve-type pain

• Symptoms radiate into the arch or toes

  
  

4. High Ankle Sprain (Syndesmosis Injury)

• Pain above the ankle joint

• Worse with twisting or weight-bearing

• Often occurs with high force or contact sports injuries

  
  

5. Osteochondral Lesion of the Talus

• Deep joint pain

• Clicking, catching, or persistent swelling

  
  

This is why accurate diagnosis is crucial, each condition requires a different management approach.

Medial ankle sprains may not be as common as lateral ankle sprains, but they’re often more complex and slower to heal. With structured physiotherapy treatment, targeted strengthening, and a tailored return-to-sport plan, most people make a full recovery and return to their normal activity levels.

If you're experiencing inner ankle pain, especially after a twist, roll, or awkward landing, early physio intervention helps ensure you heal properly and avoid lingering stiffness or instability.

If you're dealing with any of these symptoms. Book with Urban Physiotherapy today! - https://urban-physiotherapy.au2.cliniko.com/bookings?business_id=423637795941128200#service