Ankle sprains are among the most common musculoskeletal injuries encountered in orthopaedic practice and result from excessive stretching or tearing of the ligamentous structures that stabilize the ankle joint. The majority of ankle sprains involve the lateral ligament complex, particularly the anterior talofibular ligament, followed by the calcaneofibular ligament. Despite their frequency, ankle sprains are frequently underestimated in severity, leading to inadequate treatment and a high risk of chronic instability and recurrent injury.

The injury mechanism typically involves inversion and plantarflexion of the foot, often occurring during sports, uneven surface walking, or sudden directional changes. Depending on the magnitude of force, ligament injury may range from microscopic fiber disruption to complete rupture. Patients usually present with acute pain, swelling, bruising, and difficulty bearing weight. Pain is localized around the lateral ankle and worsens with movement or weight-bearing.

Orthopaedic evaluation begins with careful clinical assessment to determine injury severity. Physical examination focuses on swelling distribution, ligament tenderness, range of motion, and joint stability. Functional testing may be limited in the acute phase due to pain. Imaging is selectively used to rule out associated fractures or osteochondral injuries, particularly when pain is severe or weight-bearing is compromised.

Ankle sprains are graded based on ligament damage. Grade I injuries involve ligament stretching without instability, Grade II injuries represent partial tears with moderate instability, and Grade III injuries are complete ligament ruptures with significant mechanical instability. Accurate grading is essential, as treatment and prognosis vary accordingly.

Management of ankle sprains emphasizes early functional rehabilitation rather than prolonged immobilization. Initial treatment focuses on pain control, swelling reduction, and protection of injured ligaments. As pain subsides, structured rehabilitation aims to restore range of motion, muscular strength, and proprioception. Failure to adequately rehabilitate the ankle significantly increases the risk of recurrent sprains.

Chronic ankle instability develops in a substantial proportion of patients following repeated sprains or incomplete healing. It is characterized by recurrent giving way, persistent pain, swelling, and functional limitation. Mechanical instability may be accompanied by neuromuscular deficits, further compounding the problem.

Orthopaedic evaluation of chronic ankle instability includes detailed assessment of ligament integrity, hindfoot alignment, and associated intra-articular pathology. Advanced imaging may be required to identify ligament insufficiency or cartilage damage. Surgical intervention is considered when structured rehabilitation fails and instability significantly impairs function.

Surgical management aims to restore ligament stability, correct biomechanical abnormalities, and prevent long-term degenerative changes. Outcomes are favorable when surgery is performed for appropriate indications and followed by structured rehabilitation.

Ankle sprains demand meticulous orthopaedic management from the initial injury through rehabilitation to prevent chronic disability and preserve long-term joint health.