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These are some common phrases I hear about ankle sprains:

“I sprained my ankle 4 months ago but it still hurts”

“After spraining my ankle, I now have pain in the back of my foot”

‘Whenever I point my foot down I have pain on the top of my foot”

“Now that I’ve rolled my ankle, my balance is way off”

“Do I need surgery since I tore a ligament in my foot?”

The Real Deal

Ankle sprains are a common debilitating injury in many sports and will continue to be as long as sports are played. And yet, they are brushed off as a minor injury.

The problem here is that they can continue to cause pain months after the initial injury AND decrease performance. The BIGGER problem is that rolling an ankle should not linger and affect performance.

The Anatomy of an “Ankle Sprain”

An ankle roll usually starts by taking a misstep or landing on something other than the ground (like your arch-nemesis’ shoe). Afterward, your foot rolls inward and your weight lands towards your lateral ankle, not the bottom of the foot. Ouch. I’ve had a few.

What goes on as you put a ton of force through structures not meant to take it on? Usually, it is not an ankle sprain. But it’s common to say it’s an ankle sprain anyway (like calling all soda Coke- who does that?). Sometimes you really do have an ankle sprain, but it’s not the most common injury.

A sprain is a ligament strain or tear. Normally, the ATF ligament on the lateral ankle is the suspected pain generator after an “ankle sprain”. But this thin ligament can tear and be painless. So what causes the pain?

Normally, you irritate the capsule that surrounds the ankle joint. This is a thick fibrous tissue that supplies the joint with nerve innervation and lubricant. This injury is called traumatic synovitis. If this is the case, it’s similar to jamming your finger while playing basketball. Again, ouch. But it’s fixable and shouldn’t linger.

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Synovitis, not a sprain.

What else can happen? Well, you can stretch these little sheaths that surround the tendons on the top of your foot. These sheaths do NOT like to be stretched, and they’ll tell you if you’ve gone too far. This type of injury is called tenosynovitis.

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Tenosynovitis, not a sprain

A Proper Treatment for an “Ankle Sprain”

Both injuries require specific treatments that dramatically improve performance and reduce pain. I recently had a volleyball player from Boise, Idaho come in after rolling her ankle. She ended up having tenosynovitis (not a sprain) that needed only 3 visits before she was back to 100%. Here’s what she had to say:

“Winner winner steak dinner! Shout out to Zona Physical Therapy!! When Tyler told me not to wear my brace, I was super nervous, like packed my brace in my bag just in case level of nervous. He said he was going to tape my foot and I was going to be fine. He legit only taped my foot, not my ankle. I made it through 6+ hrs of volleyball with NO cramping and NO hurt ankle. 5 days ago I couldn’t make it past 1.5 games without issues.”



Reach out if you have been misdiagnosed with an ankle sprain and are still having pain. You don’t need to continue to have pain. A correct diagnosis and treatment can go a long way in your health and performance.