Ankle Sprains: Risks of Recurrence, Fracture Concerns, and Prevention Strategies

Ankle sprains are one of the most common musculoskeletal injuries, particularly in sports and physical activities. While many recover fully, a significant percentage of individuals experience recurrent sprains or develop chronic ankle instability (CAI), increasing the risk of long-term functional impairment. Understanding risk factors, preventive strategies, and when to suspect a fracture is essential for proper recovery and long-term health.

Why Do Ankle Sprains Recur?

Research suggests that up to 34% of individuals who suffer a lateral ankle sprain (LAS) experience a recurrence within a year. Moreover, approximately 33% develop CAI, which is characterized by persistent pain, instability, and frequent sprains over time (BMJ Open)【10】. Several factors contribute to recurrence:

• Ligament Laxity: Once ligaments are stretched or torn, they may not regain full strength, making the ankle prone to reinjury (BJSM)【8】.

• Proprioception Deficits: Poor balance and neuromuscular control increase the likelihood of spraining the ankle again.

• Inadequate Rehabilitation: Many individuals return to activity too soon without restoring full strength, range of motion, and stability (BJSM)【9】.

• Sport-Specific Risks: Activities like basketball, volleyball, and soccer have high rates of ankle sprains, particularly in jumping and cutting movements (BJSM)【8】.

Preventing Recurrent Ankle Sprains

To minimize the risk of recurrence, rehabilitation and preventive measures should focus on:

1. Balance Training: Proprioceptive exercises, such as single-leg stands on unstable surfaces, improve neuromuscular control.

2. Strengthening Exercises: Targeting the peroneal muscles and intrinsic foot muscles helps stabilize the ankle joint.

3. Bracing or Taping: Evidence suggests that ankle braces reduce reinjury risk, particularly in high-risk sports (JOSPT)【7】.

4. Gradual Return to Sport (RTS): The PAASS framework recommends assessing pain, mobility, sensorimotor control, and functional performance before resuming high-impact activities (BJSM)【9】.

When to Suspect a Fracture?

While most ankle sprains do not involve fractures, certain signs warrant medical evaluation:

• Severe pain and swelling that does not improve within 48 hours.

• Inability to bear weight immediately after injury and beyond 24 hours.

• Bony tenderness, particularly at the lateral or medial malleolus, or along the 5th metatarsal.

• Visible deformity or abnormal joint positioning.

The Ottawa Ankle Rules, a clinical decision tool, help determine whether X-rays are necessary to rule out fractures. If the injured person cannot walk at least four steps immediately post-injury or exhibits tenderness in specific ankle and foot areas, imaging is recommended (BJSM)【8】.

Conclusion

Ankle sprains may seem minor but can have long-term consequences if not managed properly. Recurrence is common, and chronic instability may develop without proper rehabilitation. Implementing strength, balance, and protective measures can significantly reduce the risk of future injuries. Additionally, recognizing signs of a possible fracture ensures timely medical intervention.

References & Further Reading

• British Journal of Sports Medicine: Clinical guidelines on ankle sprain treatment and prevention【6】【8】.

• Journal of Orthopaedic & Sports Physical Therapy: Ankle bracing and rehabilitation strategies【7】.

• BMJ Open: Study on chronic ankle instability development【10】.