Ankle Sprain in Ankara, Turkey

Prof. Dr. Murat Demirel, one of the best orthopedic doctors in Ankara for the treatment of ankle sprains, stands out with his many years of experience in diagnosing and treating this common injury that results in strain or tearing of the ligaments. Ankle sprains usually occur during sudden twisting movements, falls, or sports activities, and if not treated properly, may lead to permanent looseness in the joint, recurrent injuries, and the risk of osteoarthritis. Among the hospitals in Ankara that treat ankle sprains, Prof. Dr. Demirel offers personalized treatment plans to his patients in centers with advanced medical equipment and high hygiene standards.

Depending on the severity of the injury, treatment may include rest, cold application, bandage or splint use, physical therapy programs, or surgical interventions aimed at repairing ligaments. Following ankle sprain treatment, adherence to medical advice ensures a fast, safe, and lasting recovery. In addition, transparent and up-to-date information about ankle sprain treatment costs in Ankara is provided, helping patients make informed decisions. You can also protect your foot health, reduce your pain, and walk safely by contacting us to make an appointment right away.

What Is an Ankle Sprain and How Is Ankle Anatomy Related to This Condition?

To better understand an ankle sprain, it is helpful to first know the structure of the ankle. The ankle joint is a complex structure formed by the combination of three bones, supported by strong fibrous tissues called ligaments. These ligaments can be thought of as steel cables holding a bridge; they stabilize the joint and allow us to safely carry our body weight with every step, run, or jump. An ankle sprain occurs when these strong cables are subjected to forces beyond their capacity.

The overwhelming majority of these injuries, about 90%, occur when the foot suddenly rolls inward (a movement called inversion in medical terms). This action suddenly stretches the ligaments on the outer side of the ankle. The entire body weight loads on the bent outer side of the ankle, leading to ligament damage. The most commonly injured and weakest of these outer ligaments is the anterior talofibular ligament (ATFL). The damage usually starts here and, if the sprain is severe, may also involve the other outer ligaments (calcaneofibular ligament – CFL and posterior talofibular ligament – PTFL).

Less commonly, sprains can occur when the foot rolls outward (eversion). In this case, the deltoid ligament on the inner side of the ankle, which is much stronger, can be injured.

Ligament damage may range from microscopic fiber tears to complete rupture. When ligaments are completely torn, after the initial painful and swollen period passes, patients often complain of ankle instability and a “giving way” sensation. Over time, this persistent instability can wear down not only the ligaments but also the bones forming the joint and the cartilage covering their smooth surfaces. This demonstrates how an injury that may seem like a simple sprain can actually pave the way for serious long-term joint problems.

An important point to remember is that structural healing of a ligament, meaning the torn ends rejoining, does not necessarily mean full functional recovery. Even the most severe ligament tears can heal non-surgically with proper treatment, but more than 40% of those who experience ankle sprains—and according to some studies up to 70%—suffer from long-term issues such as chronic pain, swelling, instability, and recurrent sprains. The main reason is the failure to regain critical neuromuscular functions such as balance (proprioception) and muscle control beyond ligament healing. Self-care or standard treatments often fall short of restoring these vital functions. At this point, a comprehensive rehabilitation program guided by an orthopedic and traumatology specialist plays a crucial role in preventing chronic problems.

What Causes an Ankle Sprain and Who Is at Higher Risk?

An ankle sprain usually happens unexpectedly in daily life, with a sudden movement. Simple incidents such as stepping into a hole while walking on uneven ground, stepping carelessly off a curb, or tripping over an object at home can cause an ankle sprain. The risk increases further during sports that require sudden stops, turns, and jumps. Basketball, football, volleyball, and tennis players are unfortunately very familiar with ankle sprains.

Due to the natural anatomy of the ankle, it is more prone to turning inward, which is why most sprains occur this way. When body weight suddenly loads on the bent ankle, the outer ligaments overstretch and become injured.

So, who is at higher risk for an ankle sprain? Certain factors increase the likelihood of this injury. Risk factors include:

• History of a previous ankle sprain
• Poor balance and coordination (postural control)
• Impaired joint position sense (proprioception)
• Weakness in the muscles around the ankle
• General ligamentous laxity (seen in some genetic syndromes)
• Limited ankle joint mobility
• High-arched (cavus) foot structure

Perhaps the most important factor is a history of a previous ankle sprain. A person who has had a first sprain has a high likelihood of experiencing it again. This is because the initial injury causes some ligament looseness, impaired balance, and muscle weakness. If these deficiencies are not corrected, the ankle becomes more vulnerable to the next stress. This creates a vicious cycle: each new sprain worsens the existing problems and eventually leads to a condition called “chronic ankle instability,” characterized by constant insecurity and recurrent sprains.

Structural predispositions such as a high-arched foot also point to congenital risk. A high arch alters the load distribution in the foot, putting more stress on the outer ligaments. This makes the person more prone to injury. In such cases, measures such as custom insoles or footwear recommendations become important.

What Are the Symptoms of an Ankle Sprain?

When you experience an ankle sprain, your body sends you various signals. Correctly interpreting these signals is important for understanding the severity of the injury and deciding what to do next. Ankle sprain symptoms generally manifest in proportion to the severity of the damage.

The most common ankle sprain symptoms are:

• Pain
• Tenderness
• Swelling
• Bruising
• Difficulty walking
• Restricted joint movement
• Instability or a “giving way” sensation

Pain is usually the first and most prominent symptom. It intensifies especially when you try to put weight on or move your injured ankle. When you touch the injured area, there is pronounced tenderness.

Swelling is the body’s natural response to injury. The body sends blood and fluid to the area to initiate healing, which leads to swelling shortly after or within a few hours of the injury.

Bruising after an ankle sprain results from internal bleeding from torn ligaments and small blood vessels, accumulating under the skin. It usually becomes more noticeable one or two days after the injury and may spread toward the heel and toes due to gravity.

The severity of these symptoms provides important clues about the extent of the injury. In a mild sprain (Grade 1), you may feel only slight pain and minimal swelling, while in a severe sprain (Grade 3), you may experience unbearable pain, balloon-like swelling of the ankle, widespread bruising, and an inability to bear weight on the foot.

It should be remembered that the symptoms of a severe ankle sprain can be almost identical to those of a broken bone. Both involve intense pain, swelling, bruising, and inability to bear weight. Therefore, it is neither possible nor correct to say “this is just a sprain, not a fracture” based only on symptoms. Especially if symptoms are severe, it is vital to consult a specialist and usually have an X-ray to rule out a fracture and plan the correct treatment.

Which Methods Are Used to Diagnose an Ankle Sprain?

When you come in with an ankle sprain complaint, we follow several key steps to establish the correct diagnosis and create the most suitable treatment plan for you. This process begins with a detailed consultation, continues with a physical examination, and, if necessary, is supported by imaging methods.

First, we listen to your story. Learning how the injury occurred, which direction your foot turned, whether you heard a sound at that moment, whether you have had similar problems before, and what your current complaints are provides the first and most important step in diagnosis. This information gives us valuable clues about the type and severity of the possible damage.

Next, we perform a comprehensive physical examination. We carefully examine your ankle, foot, and lower leg. We gently touch the area to identify the points of greatest tenderness. We check your joint range of motion and slowly move your foot in different directions to understand which movements cause pain. We may also perform special tests such as the “drawer test” or “tilt test” to assess possible ligament tears or looseness. These tests help us understand how stable your joint is.

In most cases, your history and physical examination findings are sufficient for diagnosis. However, in some cases, especially when we suspect a fracture or want to clarify the extent of the damage, we use imaging methods.

The main imaging tests we use are:

• X-ray
• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT)
• Ultrasound

X-ray is usually the first method we use. Its main purpose is to check whether there is a fracture or crack in the bones. Remember, about 15% of ankle sprain cases are accompanied by a fracture. Therefore, if you have severe pain and cannot bear any weight on your foot, an X-ray is essential.

MRI provides detailed imaging of soft tissues such as ligaments, tendons, and cartilage rather than bones. We generally do not request MRI for a routine sprain. However, if your symptoms persist for a long time, if a chronic instability has developed, if we suspect cartilage damage or a high ankle sprain, or if we are considering surgery, MRI offers very valuable information for a definitive diagnosis.

CT is mostly used to examine bone details, while ultrasound is useful for dynamic evaluation, meaning observing the condition of ligaments while your foot is moving.

The diagnostic process is completed by combining all these steps. Correct diagnosis is the foundation of proper treatment and the first step in returning you to your daily life as soon and as healthily as possible.

What Are the Non-Surgical Treatment Options for an Ankle Sprain?

One of the most frequently asked questions by our patients is whether surgery is necessary after an ankle sprain. The good news is that the vast majority of ankle sprains—even severe cases with complete ligament tears—can be successfully treated with a proper and comprehensive non-surgical program. Non-surgical treatment is not a passive waiting period but rather an active, step-by-step program requiring participation and patience.

This program usually consists of three main phases:

Phase 1: Protection, Pain, and Swelling Control (Usually the first week)

The main goal in this initial stage is to prevent further damage to the injured tissues and to control the body’s immediate responses of pain and swelling. During this period, the R.I.C.E. protocol or similar first aid procedures continue to be applied. Depending on the severity of the injury, a removable brace, walking boot, or in more serious cases, a short period of casting may be used to protect and rest the ankle. As pain allows, controlled weight-bearing is encouraged, as it increases blood circulation and promotes healing. If you have difficulty walking, crutches will be your best friend during this time.

Phase 2: Regaining Motion and Flexibility (Usually 1–3 weeks)

Once pain and swelling are under control, the second phase begins. The goal of this phase is to prevent stiffness and gradually restore the ankle’s normal range of motion. During this period, immobilization is discontinued. Gentle range-of-motion exercises guided by a physiotherapist are initiated. Simple exercises such as slowly moving the foot up and down, inward and outward, help re-lubricate the joint. At this stage, basic exercises aimed at restoring balance and muscle strength are also started.

Phase 3: Strength, Balance, and Return to Function (Usually after the 3rd week)

This final and most important phase aims to restore the ankle’s previous strength and functionality. The intensity and difficulty of exercises are gradually increased during this stage.

The main types of exercises in this phase include:

• Strengthening exercises
• Balance (proprioception) exercises
• Flexibility exercises
• Sport-specific movements

Resistance bands or light weights are used to strengthen all the muscles supporting the ankle. Balance exercises, perhaps the most critical part of rehabilitation, are emphasized in this phase. Standing on one foot, trying to maintain balance with eyes closed, or performing exercises on balance boards restore communication between the brain and the joint, effectively preventing recurrent sprains. Finally, more complex and sport-specific movements such as running, jumping, and sudden direction changes are gradually introduced, ensuring a safe return to daily life and sports.

The duration of this three-phase program depends on the severity of the injury and the individual’s healing speed. While this process may be completed in a few weeks for a mild sprain, it may take 6 to 12 weeks or even longer for a severe injury. Patience and progressing under expert guidance are key to achieving the best outcome.

When Is Surgical Treatment Considered for an Ankle Sprain?

Surgery is usually the last option we consider in the treatment of ankle sprains. The most important thing our patients should know is that surgery is rarely necessary. The vast majority of cases heal with the comprehensive and disciplined non-surgical program mentioned earlier. However, in some special situations, surgical intervention may be the most appropriate and permanent solution.

So, when do we consider surgery for an ankle sprain? Situations that may require surgery include:

• Persistent complaints despite long-term (usually 3–6 months) and properly applied non-surgical treatment
• Chronic instability with a constant feeling of “giving way” or “slipping” in the ankle, affecting daily life
• Recurrent sprains impairing performance, especially in professional athletes
• Presence of another problem requiring surgery along with ligament injury (e.g., cartilage damage or a loose bone fragment)

If surgery is decided, our goal is to restore the mechanical stability of the ankle joint by repairing or reconstructing the damaged ligaments. Today, various surgical techniques are available for this purpose.

The most commonly preferred and widely performed method is the “anatomical repair” technique. In this method, the patient’s own torn and loosened ligaments (usually ATFL and CFL) are repaired and tightened. The most well-known procedure is the Broström-Gould repair. In this procedure, the torn ligament ends are stitched together or reattached to the bone with special sutures. This method preserves the natural structure of the joint and does not restrict its movements, providing highly successful results. Often this procedure can also be performed arthroscopically (minimally invasive) through small incisions, meaning less pain and faster recovery.

In rare cases, if the patient’s own ligament tissue is too weak or insufficient for repair, reconstruction techniques are used. In this method, a tendon graft taken from another part of the patient’s body or a donor tendon graft (allograft) is used to replace or reinforce the torn ligaments.

The decision for surgery is a personal one, made together with the patient by considering factors such as age, activity level, expectations, and characteristics of the injury. In the postoperative period, a comprehensive physical therapy and rehabilitation program is again essential for treatment success.

Frequently Asked Questions