Condition Spotlight: Medial Ankle Sprains

When we hear about an ankle sprain, we automatically think of a lateral ankle sprain.

After all, research suggests that they do account for approximately 85-90% of all ankle sprains.

But what about the other 10-15% of ankle sprains?

Here, we will cover the less likely ankle sprain – the medial ankle sprain.

What is a medial ankle sprain?

Also known as an eversion ankle sprain, a medial ankle sprain occurs when the ankle rolls inwards towards the midline.

Firstly, let’s have a look at the anatomy of the area.

The main area of the ankle that is injured during a medial ankle sprain is the deltoid ligament.

This ligament is triangular in shape and is usually very strong.

It comprises of 4 ligaments that hold 4 bones together – the tibia (shin bone), the calcaneus (heel bone), the talus and the navicular.

In addition to these ligaments, there are many smaller ligaments that sit deeper that also holds this part of the foot and ankle together.

The role of the deltoid ligaments is to provide stability to the medial side of the ankle and foot.

It is rare for the deltoid ligament to rupture completely, however if the fibula bone is fractured, the deltoid ligament has less protection.

Another area that can be injured in the medial ankle sprain is the lateral malleolus.

This is due to the force of the movement through the lateral ankle, often forcing the lateral malleolus and the calcaneus (heel bone) to connect.

The lateral malleolus is the end of the fibular, the smaller bone located in the lower leg.

This type of fracture is called a Pott’s fracture.

In severe cases, the talus bone can also fracture.

The other area that can be damaged in a medial ankle sprain include the structures within the tarsal tunnel. The tarsal tunnel holds 6 structures:

  • Tibialis posterior tendon
  • Flexor digitorum longus tendon
  • Flexor hallucis longus tendon
  • Tibial artery
  • Tibial vein
  • Tibial nerve

What does a medial ankle sprain feel like?

A medial ankle sprain will result in immediate pain through the medial ankle. This pain can radiate throughout the rest of the ankle, particularly if the lateral malleolus is damaged as well.

Patients will struggle to place weight through the ankle and it may be painful to move the ankle joint through its range of motion.

Swelling and bruising through the medial ankle are also often seen in a medial ankle sprain.

What causes a medial ankle sprain?

This type of ankle sprain can occur in the same instances as it’s counterpart, the lateral ankle sprain.

The difference is in the force that is placed on the ankle and the position that it is forced into.

It can occur due to a simple loss of balance, slipping or tripping on uneven ground, or it can occur if something or someone falls on to the outside of the ankle.

It is most common in sportspeople and those playing in change of direction or contact sports including football, rugby, netball, basketball, hockey and lacrosse.

How is a medial ankle sprain diagnosed?

Diagnosis of a medial ankle sprain is generally quite straightforward.

Patients typically recall when the injury occurred and how it occurred, with most saying that their ankle ‘collapsed or twisted inwards’.

Bruising and swelling can help to identify the injured structures.

We perform a variety of tests depending on the severity of the medial ankle sprain. These can include palpating the injured structures, range of motion and muscle strength testing, standing and gait assessments and sport specific exercise assessments.

In some cases, we may refer you for scans such as an X-ray, ultrasound or MRI if we believe that the structures of the ankle are significantly damaged which can include fractures or ruptured ligaments.

How is a medial ankle sprain treated?


The principle of rest, ice, elevation and compression is extremely important as soon as possible after an acute injury to help the initial healing process.

This will help to reduce pain, swelling and bruising.


Taping is a great short term option to provide support to the structures whilst still being able to move the ankle through a good range of motion.


Bracing is a long term option to help negate chronic ankle pain and instability.

It is sometimes necessary in order to provide enough support to the ankle during sport or physical activity.

Strengthening and balance program

A rehab program should be implemented relatively soon after a medial ankle sprain, depending on the extent of the injury.

Exercises can include:

  • Passive range of motion exercises
  • Strengthening exercises using a theraband
  • Balance exercises – on a flat ground and then on uneven surfaces such as a wobble board
  • Calf raises to increase the strength of the lower leg
  • Hopping and jumping exercises
  • Sport specific exercises including pivoting and change of direction

Mobilisation and manipulation

This can help to reduce tension through the foot and ankle joints and assist in alignment.

Dry needling

Dry needling can help to reduce tension in the structures of the lower leg than may be compromised in a medial ankle sprain.

It helps to eliminate trigger points and reduce pain. In the instance of a medial ankle sprain, the tibialis posterior tendon and the peroneal tendons would be treated.


Shockwave helps to kick start the healing process of chronic injuries.

If someone has sustained repeated medial ankle sprains due to ankle instability, shockwave can help to heal these tissues and reduce pain.


Orthotic therapy can help to realign and support the structures within the foot and ankle. If instability through the medial ankle is noted and the patient is having repeated medial ankle sprains, orthotics can help to reduce the risk of reinjury by supporting the medial aspect of the foot and ankle.

Visit Watsonia Podiatry if you’ve injured your ankle

If you’ve suffered a medial ankle sprain, an ankle injury of any sort, or you’re experiencing pain or discomfort in your feet and/or lower limbs, you should get checked out by a podiatrist.

We can help assess, diagnose and treat any conditions that may be causing this pain.

Book in to see us by calling us on 03 9432 2689 or online here.

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