Our Clinical Approach to Ankle Sprain

Feb 6, 2026 | dr-chirag-arora, Gurgaon, Health, Orthopedics

By Dr. Chirag Arora

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Our Clinical Approach to Ankle Sprain

Below is a stepwise orthopedic workflow we use in our clinic.

Mechanism of injury

  • Inversion → ATFL injury (outside sprain) (most common)
  • Eversion → deltoid ligament (inside sprain)
  • External rotation → syndesmotic (high ankle sprain)

Red flags

  • Unable to bear weight immediately 
  • Severe swelling within an hour (fracture)
  • Locking/catching 
  • Medial pain (deltoid injury)

Imaging

X-ray is almost always required, unless clinical decision is otherwise:

  • bone tenderness OR
  • unable to bear weight

MRI indications (never required before 6 weeks)

  • persistent pain > 6 weeks
  • recurrent
  • elite athletes (off season)
  • suspected osteochondral defect

Grading

GRADE 

PATHOLOGY

CLINICAL

I

Stretch

mild swelling, stable

II

Partial Tear

moderate pain, laxity

III

Complete Tear

gross instability

 Management Protocol

Acute phase (0–2 weeks)

PRICE protocol

  • Protection (brace/Cast)
  • Rest 
  • Ice
  • Compression
  • Elevation

Medications

  • Anti-inflammatory medications – short course 5-7 days
  • Early weight bearing as tolerated
  • Physiotherapy (Range of motion)

Walking Cast may be required

  • Severe swelling 
  • Fracture
  • Repeated ankle sprains
  • High grade injury

Return to sport criteria

    • full ROM
    • no swelling
    • 90–95% strength
    • single leg hop pain free
    • good proprioception

       Timelines:

    • Grade I → 1–2 weeks
    • Grade II → 3–6 weeks
    • Grade III → 6–8 weeks

    Surgical indications

    • chronic instability (> 3 months)
    • Recurrent swelling episodes during sports
    • Ankle instability (Exam)
    • syndesmotic diastasis
    • associated osteochondral lesion

    Options

    • Arthroscopic surgery (Brostom-gould repair)

    Our Practical Approach template

    Grade I–II

    • No immobilization required
    • Walking allowed
    • NSAIDs 5 days
    • Supplements
    • physio referral (ROM + strengthening)
    • review 14 days

    Grade III

    • Walking cast 2 weeks
    • Medications
    • supplements
    • structured rehab
    • reassess 6 weeks
    • return to sports > 6 weeks

    IF SYMPTOMS ARE PERSISTENT BEYOND 6 WEEKS, PROGRESS TO MRI.

      Consult Dr. Chirag Arora, Best , for expert evaluation, personalized rehab, and safe return to sports.

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