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

After the summer break, you’re ready to get back into exercise. You put on your shoes, pop on your headphones and head out the door on your first run of the new year.

But as you step out onto the footpath, disaster strikes. You trip and land awkwardly.

A sharp pain shoots along the outside of your ankle. Before you know it, your ankle has swollen like a balloon. Did you sprain it or twist it? Is there’s even a difference?

People often use the terms “sprained” and “twisted” ankle interchangeably. But in practice, there is a small difference.

The ankle is complex and vulnerable

The ankle is a complex joint. It’s made up of three bones, the:

• tibia (the shin bone)
• fibula (the thinner bone on the outside, next to it)
• and talus (the bone underneath these two that connects the shin to the foot).

Several strong bands of tissue, known as ligaments, hold these three bones together to keep the joint stable. Several muscles and tendons that surround the ankle also help you maintain balance and allow you to move your ankle.

While the ankle needs to be stable enough to support your weight, it also needs to be mobile enough to allow you to walk, run and jump. This means it can move in a lot of different, and sometimes unexpected, ways.

This also makes it more vulnerable to injury. For example, when you land with your foot turned inwards, a lot of force is placed through a small area on the outside of your ankle, which can lead to injury.

In fact, the ankle is the most commonly injured joint in the lower body.

What is a sprained ankle?

A sprained ankle occurs when the ligaments around the ankle stretch or tear. This most commonly happens when the foot rolls inwards (known as an inversion or a lateral ankle sprain) and ligaments on the outside of the ankle are damaged. However, a sprained ankle can also happen in other ways.

Ankle sprains are typically graded based on their severity:

Grade 1: the ligaments are stretched but not torn or have had a very small tear. There will be minor swelling, and the ankle will be tender to touch.

Grade 2: the ligament is torn, but not all the way through. There will be moderate pain, moderate swelling, and it will hurt to move.

Grade 3: the ligament is completely torn all the way through. There will be significant swelling, bruising and it will be very painful to move.

So an ankle sprain refers to damage to the ankle ligaments.

This is what a clinician will diagnose after assessing your swelling, tenderness and pain. Depending on what they find, they may send you off for an X-ray to make sure you haven’t fractured any ankle bones.

What is a twisted ankle?

A twisted ankle is not a specific diagnosis, but a broad term. It normally relates to the ankle rolling or twisting awkwardly.

In short, you can think of a twisted ankle as how the injury occurred, and a sprained ankle as what the injury is.

You can twist your ankle without spraining it. For example, you might land awkwardly, feel a tweak of pain, but then walk away with no structural damage.

But twisting the ankle has also been linked to more severe injuries, such as ankle breaks and fractures.

How should we treat them?

When it comes to treatment, we should really consider how the ankle feels rather than how it happened.

The first thing is to make sure you haven’t fractured any of the bones in your ankle.

Clinicians use the Ottawa ankle rules to decide whether you need to get an X-ray. This is based on assessing your swelling, tenderness and pain.

If you don’t need an X-ray, the priority is to manage the pain and swelling.

The first step is to temporarily limit the amount of weight you put through your ankle. You can lie on the sofa with a cushion under your ankle or you can use crutches. You might also want to wear some form of compression bandage, which can reduce swelling and reduce pain.

After about 48–72 hours, your ankle will generally start to feel a bit better. This is when you can start doing some basic exercises to restore your ankle’s range of motion, strengthen the muscles around the ankle, and improve balance.

These exercises are important. If you’ve had one ankle sprain, this is the biggest risk factor for having another. These exercises can restore muscle strength and stability back to your ankle, which may help prevent future sprains.

There is some debate about whether the common recommendation to apply ice to the ankle improves recovery. Evidence seems to suggest that simply limiting swelling and starting exercise early will be more effective.

So, is a sprained or twisted ankle the same?

Well, kind of – but not exactly.

Most people who say they twisted their ankle probably had a mild sprain. But not all twisted ankles are sprained ankles.

If you think you have sprained your ankle, it might be worth getting it checked out by a medical professional just in case.