Sprained or strained ankle: what’s the difference?

Written by: Mr Jordi Sanchez-Ballester
Edited by: Cameron Gibson-Watt

Ankle injuries are common and account for around 10% of all A&E attendances - that’s 302,000 in total per year in the UK. However, considering how common they are, would you be able to tell the difference between a sprain and a strain? Mr Jordi Sanchez-Ballester, consultant orthopaedic surgeon based in St Helens and Warrington, is here to explain the difference.

What’s the difference between a sprained ankle and a strained ankle?

The difference between a sprain and a strain is that a sprain injures the bands of tissue (ligaments) that connect two bones together, while a strain involves an injury to muscles or tendons that attaches a muscle to a bone due to overstretching or tearing of the muscle. In addition, with a sprain you may have bruising around the affected joint, whereas with a strain, you may have spasms in the affected muscle.


What causes strains and sprains?

Muscle strain is an injury to muscle as a result of strenuous activity. Almost anyone can put undue tension on muscles during normal daily activities, with sudden, heavy lifting, during sports, or while performing work tasks. Muscle strain is sometimes referred to as a ‘pulled muscle’. A severe muscle strain can result in a muscle tear which can also damage small blood vessels, causing local bleeding (with or without bruising) and pain (caused by irritation of the nerve endings in the area).


A sprained ankle is typically caused by twisting your joint with force. When this occurs, your joint moves in an unnatural way and the ligament gets stretched and pulled. This can result in pain, swelling, bruising and a limited ability to move the affected joint.


How do you treat a strained or sprained ankle?

To effectively treat a strained or sprained ankle you should:

  • Protect the strained muscle around the ankle from further injury
  • Rest the full ankle
  • Ice the area (20 minutes every hour)
  • Apply compression gently with an elastic bandage, which can provide support and decrease swelling

If severe pain and bruising occur, I would advise seeking physiotherapy advice.


Mild sprains can usually be treated at home, but for more severe injuries, surgery may be required to repair any damaged ligaments, tendons. If you are experiencing any of the following, then you should visit your doctor to get it checked out:

  • Inability to move the affected joint
  • Difficulty standing or walking with pain
  • The joint feels numb and tingly


What is a lateral ligament sprain?

Over 90% of ankle ligament sprains involve the lateral ligament complex. This part of the ankle is a set of three ligaments that prevent the ankle from inverting. When the ankle does invert too much it causes what’s called an inversion (lateral) ankle sprain – the most common type of ankle sprain. Lateral ankle ligament sprains are common in young athletes.


Are there any complications?

In around 10% - 30% of cases, patients experience some pain even after the injury has healed and between roughly 10% - 40% of cases, patients report having recurrent sprains and feelings of instability.


In order to avoid this type of recurrence, it’s recommended to do the following:

  • Get an assessment done by an experienced clinician
  • Diagnose instability of the ankle on the day of injury or within 48-72 hours
  • Follow the RICE protocol within 48 hours for minor stable injuries
  • Both major injuries and unstable injuries should receive an ankle brace and referral to the physiotherapist
  • Try exercises that strengthen the ankle muscles and avoid high-risk activities


Chronic ankle instability is a condition in which the ankle has the sensation of giving way and can develop after a severe ankle sprain or a sprain that wasn’t treated appropriately at first. Typically, the giving way occurs while walking, standing or carrying out day-to-day activities.


If you have an injured ankle that is failing to set after 6-8 weeks, I recommend going to see an orthopaedist and having an MRI scan done to check over the injury.


If you are experiencing any of the symptoms mentioned in this article and would like to see Mr Jordi Sanchez-Ballester, visit his profile and book a consultation to see him.

By Mr Jordi Sanchez-Ballester
Orthopaedic surgery

Mr Jordi Sanchez-Ballester is a leading consultant orthopaedic surgeon based in St Helens and Warrington, at the Fairfield Independent Hospital and the Spire Cheshire Hospital respectively. He specialises in lower limb foot and ankle treatment, as well as knee surgery, trauma surgery and osteoarthritis. Mr Sanchez-Ballester trained in Barcelona, Spain where he is from and completed his postgraduate studies in London and Manchester.

Mr Sanchez-Ballester is a fellow of the British Orthopaedic Association and member of the British Orthopaedic Foot and Ankle Society. He has many publications in his areas of expertise, and also an honorary senior lecturer at the University of Liverpool. Alongside his surgical and clinical commitments, Mr Sanchez-Ballester is presently the Clinical Director of Trauma and Orthopaedic Surgery at the St Helens & Knowsley Teaching Hospitals NHS Trust.

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