Growing up as an athlete, I remember many basketball games where I landed funny and then “rolled” my ankle. Lucky for me, my ankles survived and did not turn into recurrent ankle sprains.
A sprain is defined as an injury to ligaments. Ligaments are tough yet flexible tissues that connect two adjacent bones. Ligaments are designed to support your moving parts. If the two ends of the ligament are stretched too far apart, it’s called a sprain. If the ligament is repeatedly stressed as in “rolling the ankle” all the time, then the ligaments lose their toughness and become stretched out. When this happens, ankle sprains can become recurrent.
With treatment, ligament tissue can heal. It’s important if you’ve suffered from recurrent ankle sprains that you learn how to protect against future sprains. When ligaments lose their ability to provide adequate support to the ankle, it can cause excess wear and tear in the ankle and rear foot.
Recurrent ankle sprains are a troublesome problem. This is particularly true for athletes who love to run, hike, play sports that require cutting and twisting motions like soccer and basketball, jumping, and climbing. The most common ankle sprain occurs on the outside or lateral aspect of the foot and ankle (see figure below.) Ligaments can take up to 12 weeks to heal and sometimes longer depending upon factors such as grade of sprain, overall health and activity level.
The most common way we sprain the lateral ankle is by rolling it where the sole of the foot points inward as our foot hits the ground. You may be thinking that this is a weird motion to perform and how could you possibly put your foot and ankle in this awkward position. It’s easy to do if you jump and land wrong, step off a curb awkwardly or catch your toe on something. The more you’ve rolled your ankle and suffered with recurrent ankle sprains, the easier it is for your ankle to roll again. The ligament system becomes lax. Here are a few things you can do to prevent recurrent ankle sprains.
5 Tips to Prevent Recurrent Sprained Ankles
1. Choose Your Footwear Based on Activity
If you plan to play basketball, choose a shoe that supports the ankle. When hiking, purchase hiking shoes with adequate ankle and arch support that help your ankle accommodate to the terrain. When running, be aware of the surface. Gravel, sand, trails and uneven pavement create increased stress to the ankle ligaments when your foot lands.
2. Strengthen Your Leg, Foot, Hip and Core Muscles
Believe it or not, how your foot hits the ground when you walk and run has as much to do with your hips, core and legs as it does with the surface you are landing on. Strong lateral leg and ankle muscles along with solid strength in hamstrings, quadriceps, gluteals and core muscles produce better alignment and support as you walk and run. Weakness in any of these muscle groups produces abnormal forces at the foot, ankle, knee and hip.
3. Improve Your Balance
How quickly you can respond to perturbations in balance plays a large role in preventing recurrent ankle sprains. All your moving parts have little sensors in them called proprioceptors. These sensors are constantly sending your brain messages regarding your body’s position in space. Once the brain receives the message, it sends a lightning fast message back to the muscles of your body. The message tells the muscles what to do to keep you balanced and upright. It’s a pretty slick system! Most of my clients with recurrent ankle sprains have impaired balance reactions. The good news is that proprioceptive training is very effective in restoring balance reactions and preventing recurrent ankle sprains.
4. Maintain Full Ankle Dorsiflexion
Sometimes after recurrent lateral ankle sprains, your ankle flexibility changes. Many times I see a loss of dorsiflexion (when you pull your toes towards your face) and this affects how you walk. Many of my clients come to see me years after their last ankle sprain and they have a noted loss of dorsiflexion and swelling on the front of their ankle. When I find this, I do aggressive stretching to the ankle joint and open up the Achilles and calf with exercises. This restores normal dorsiflexion and allows the ankle to sit in the middle with walking. This is essential in the prevention of ankle sprains, especially lateral ankle sprains.
5. Use the Big Toe
Another common pattern I see when treating people with recurrent ankle sprains is that they walk toward the pinky toe side of the foot. In other words, they tend to keep more weight on the outside of the foot when walking. The next time you walk, try to notice where you feel the weight on the bottom of your foot. Is it centered, or is it on the big toe or pinky toe side? When your foot is behind you, most of your weight should flow through the big toe as your foot rolls off the ground. People with recurrent ankle sprains tend to either “duck out” the feet or walk on the outside of the feet. Learn to use your whole foot and roll off the big toe side of your foot. Doing so may prevent recurrent ankle sprains.
Whether you’ve suffered from your first ankle sprain or your 12th ankle sprain, there’s always something you can do to prevent future sprains. The best first step is to seek counsel from a physical therapist. Read my blog on “How to Find a Good PT” and visit apta.org to find one in your area. If you live in the Portland metro area and are suffering from recurrent ankle sprains, please contact us at 503-295-2585 or info@lifesworkpt.com.
All the best wishes for you and your ankles with all your summer activities!
Sandra
Thank you this was super helpful and very informative
Thanks for the article , I’m on my third injury to my left ankle it happened eight months ago and it’s still not better maybe cause I stopped doing the excerises that my phyiso gave me. I just wished I knew why it’s not getting better, I’ve seen two different types of Doctors none of them know what my injury is. I’m just getting frustrated with my ankle that it’s still sore most days I can hardly weight bare or walk with out pain
We’re sorry to hear about your ankle injuries and pain. Unfortunately, we can’t speak to your particular situation without evaluating you first. If you live in the Portland, Oregon area we would love to help you! Please contact our office at (503) 295-2585 to schedule an initial evaluation. If you live outside of Portland, to find a good physical therapist in your area, visit http://www.apta.org. Try to find one with the designation of FAAOMPT (fellow in orthopedic manual physical therapy), who does hands-on treatment as a standard part of care. You can read more about how to find a good PT in our blog post: https://lifesworkpt.com/2017/03/how-to-find-a-good-pt/
Best of luck!
I have
Really helpful, thank you!
I have rolled my ankle about 30 times… at least once a year! I have had physio and do yoga and balance and weights… I always think it’s better. It just takes me by surprise. I have 1 leg longer than the other which is y I have slot of problems
Thank you for your comment Charmaine. As you have experienced, the more often you roll your ankle, the more likely you are to roll it again in the future. Leg length differences can definitely play a role. You are on the right track working on balance, this is especially important, especially single leg balance. I recommend talking to a physical therapist about your leg length difference and to see if your balance exercises are challenging enough. If you would like to schedule an evaluation, give us a call at 503-295-2585.
I have had 3 sprains on left foot now and am an avid hiker, skier, pilates and walker – The most recent sprain was in the UK missing a step on the bottom of a marble stairwell and falling flat – I have never been told about using the big toe and yes, I do tend to walk on the outside of my foot – so this was valuable information for me – thank you!
You’re welcome! We’re glad you found it helpful.
Thank you for the tip re walking and rolling off your big toe. I’m elderly but reasonably fit. I’ve just broken my shoulder and a couple of years ago broken wrist. All this because I rolled my ankle causing me to fall. Nobody told me the correct way to walk and I do a lot of it. Once again thanks, I’m going out to practice. Cheers Lesley
Hi Lesley – We’re glad you found our blog helpful! Best of luck as you recuperate from your broken shoulder. Keep on walking! 🙂
Thank you for sharing the knowledge. I practise the correct technique of walking after i recover out of this ankle sprain. I have actually realized that i use the outside of my foot as i walk and also tried to correct it but never cared for it much, until now. I have also started to feel like these recurring insidents with my ankle have something to do with uneven leg height. The ankle on the shorter side suffers as it fails to land after having travelled the same distance as the other side. (Plus the darn uneven surfaces it always lands on)
I keep rolling my right ankle – and just had the third fall walking on a flat surface! I am 51 and love the gym. The problem is that I have arthritis in my big toes. I have just had a cortisone injection in my right big toe which has alleviated the problem for now. I think you are right and I think I try not to walk on my big toe because of the pain. Is there anything else that you can suggest.
I keep rolling my ankles… yes bith of them. Ill get one healing the the other will go out. This has been an on and off problem since 2011. Even the slightest uneven surface and my ankle rolls. Is there a way to help prevent this. I cant take this much more.
We’re sorry to hear that. If you live in the Portland, Oregon area, we’d love to help you! Best of luck.
I have sprained my left ankle very badly three times now what do I do?
We’re sorry to hear about your ankle sprains. Unfortunately, we can’t speak to your particular situation without evaluating you first. If you live in the Portland, Oregon area we would love to help you! Please contact our office at (503) 295-2585 to schedule an initial evaluation. If you live outside of Portland, to find a good physical therapist in your area, visit http://www.apta.org. Try to find one with the designation of FAAOMPT (fellow in orthopedic manual physical therapy), who does hands-on treatment as a standard part of care. You can read more about how to find a good PT in our blog post: https://lifesworkpt.com/2017/03/how-to-find-a-good-pt/
Best of luck!
Excellent article. I’ve had recurring ankle sprains or rolled ankles for 20 years and realized I do walk on my pinky toe more than my big toe. I also “duck out” my right foot, the ankle I seem to sprain about every 2 years.
In my experience, the dorsiflexion stretches help tremendously and so does working on balance and overall ankle / foot strength. I also have chronically tight calves and recurring plantar issues and the stretches help that as well.
Sitting here with my ankle wrapped and elevated after I sprained it in a hole yesterday!
Thank you for the feedback! Stiffness in the ankle is really common after a sprain, I’m glad the dorsiflexion stretches help so much. I’m sorry you sprained it again but keep up the good work with your strengthening and balance program. If you would like to start a PT program give us a call at 503-295-2585. We can support patients in-clinic or through telehealth visits. Stay well Michael.
I am a Cross Country Runner and while I was running on the tracks, I accidentally sprained my ankle. I was so shocked. The pain was extreme but I managed to run the rest of the tracks that I had to run after resting for a while. About 3 weeks had passed since my sprain and our team ran up and down a mountain and I really sprained my ankle so bad by tripping on a branch and landing on the outer part of my foot. IT WAS THE SAME ANKLE!! It was so painful but once again, after a rest, I managed to bring myself back up to finish the course. This Saturday, I have to run again and it’s a big tournament. I’m not so sure if I’m supposed to rest in tomorrow’s practice and go to the tournament or do neither… It hurts and I really need to heal it quickly. What could be some tips of how the ankle could heal quicker? Would you recommend putting an icepack on the sprain or hot water on it? Thank you!
So sorry to hear about your recurring ankle sprain! It is actually not uncommon to re-sprain an ankle shortly after an initial sprain. When you sprain your ankle, your ligaments that support your bones have stretched past where they want to go. Ligaments take a long time to heal (about 12 weeks minimum) and it’s important that the ligaments heal prior to stressing them. To help ligaments heal and to reduce the potential load on your healing tissues, we recommend icing and elevating your ankle to reduce inflammation and swelling. You should also be wearing supportive shoes that have a wide base of support to prevent your foot from rolling onto the outside part of your foot. If you have access to an athletic trainer, they can tape your ankle to support the outside of your foot or you can wear a lace up ankle brace to provide your foot with more support. Also, think about your walking and running mechanics–when your heel makes contact with the ground, try and push off your big toe when striding forward rather than rolling off your pinky toe. This helps decrease the loading off the outside of your foot. These are all things that will help healing in the short term but most important is time.
Ultimately in the long term, your foot, knee, hip, and core all need to be strong to support that sprained ankle and prevent future sprains. This is something you can work on with a Physical Therapist. Call our clinic at 503-295-2585 we offer in-person and telehealth visits.
Thanks for this article.
(Strengthen Your Leg, Foot, Hip and Core Muscles) I will focus on this a lot more. After taking 6 weeks off running after left knee injury I started walking 10ks then adding light runs throughout the walks.
A week ago I rolled my right ankle which was a little painful. Some ice and some diclofenac potassium I felt pretty good. Now after day three of my increased running being mindful of my knee and ankle, I rolled my ankle again walking my puppy. Ouch!!!
My hips feel sore and weak. (From the walk) I wish I was my careful, understanding more now that it’s all connected.
Time to strengthen my core!
Hello Mark. We are happy to hear that you found the article helpful. We help runners get stronger and back to sport everyday. If you would like to work with one of our physical therapists 1-on-1 please give our clinic a call (503-295-2585). We see local patients in our clinic and patients located nationwide through Telehealth.
Thanks so much for this information, I play netball, not sure if you know the sport but it requires you to stop each time you are holding the ball, I’m only 16 but have twisted and possibly sprained my ankle 7 times on my right foot and 3 on the other, I love playing and I never fully let them heal most of the time, but after COVID when sports were cancelled I didn’t play for an entire year so I thought that I was fully recovered. Just earlier today I twisted my ankle when falling on a completely flat netball court as someone knocked me over. Without evaluating what would you suggest I do? Play less competitively? Also after this recent injury how many weeks should I stop play for?
Hi Jennifer, thank you for your comment. For your current injury I recommend not playing again until you can walk and run without pain or without the ankle swelling up. To prevent future injuries I would focus on balance exercises both double and single leg. Exercises that work on stability are what is going to help in the long term. I would suggest talking to a physical therapist to prevent these repeated injuries from occurring. If you would like to schedule an evaluation, please give us a call at 503-295-2585.