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Most people treat a rolled ankle with a bag of ice and carry on. But according to Dr. Gowreeson Thevendran, orthopedic surgeon at Island Orthopedic Clinic Singapore, this approach can lead to long-term damage — and even permanent disability — if the right structures are not properly assessed and treated. In this edition of Physioactive’s Singapore Surgeon Insights series, Dr. Gowreeson explains what really happens during an ankle sprain, when to seek help, and how modern surgery and physiotherapy can get you back on your feet faster than ever.
Why Ankle Sprains Are Often Underestimated
The common assumption is that an ankle sprain only affects the ligaments. In reality, depending on the force of the injury, other structures can also be damaged — specifically the bone, cartilage, or tendons.
When these are involved alongside a ligament injury, recovery becomes significantly more complex. Left untreated, some of these injuries can result in chronic pain, instability, or permanent disability.
Dr. Gowreeson sees approximately 8 to 10 ankle sprains every week in his practice, and notes a growing trend: an aging, more active population is presenting later with the consequences of ankle sprains that were never properly managed.
Red Flags: When an Ankle Sprain Is Not “Just a Sprain”
A straightforward ankle sprain should improve significantly within two to four weeks and be almost fully resolved by six weeks. Seek specialist assessment if you notice:
- Persistent swelling beyond four weeks that is not resolving
- Pain concentrated on the outer side of the ankle
- Swelling and pain that is activity-related — worsening the more you stand or walk
These are signs that something beyond a ligament injury may be at play — such as cartilage damage, a tendon injury, or a small bone avulsion — none of which are visible on a standard X-ray.
How Dr. Gowreeson Approaches Assessment and Treatment
The most critical factor is how quickly the patient presents after the injury.
Within 48 hours: The priority is to reduce inflammation and protect the ankle. Treatment includes a walker boot, crutches for 7–10 days to offload the ankle, ice, elevation, and anti-inflammatories. At the 7–10 day review, if the ankle has improved by 50–60%, the patient gradually transitions out of the boot — and this is when physiotherapy begins.
Later presentations (2–8 weeks post-injury): If the ankle is still painful and swollen, immobilization alone is unlikely to help. An MRI scan is the first step to identify cartilage injuries, tendon damage, or bone avulsions that require targeted treatment.
When Surgery Is Needed
Thanks to advances in minimally invasive techniques over the last 5–10 years, ankle ligament surgery can now be performed through small keyhole incisions using a camera (arthroscope). This allows the surgeon to repair ligaments and resurface cartilage in the same procedure.
Key details for patients considering surgery:
- Procedure time: Approximately 1 hour 15 minutes under general anaesthetic
- Hospital stay: Day surgery or one overnight stay depending on timing of procedure
- Day 2–3 post-op: First wound check; cast replaced with a removable boot — patients travelling from Indonesia are typically cleared to fly home at this point
- Week 2: Stitches removed; physiotherapy begins
The Recovery Timeline: Week by Week
Dr. Gowreeson provides one of the most detailed recovery roadmaps you will find:
- Weeks 1–2: Boot and crutches; no weight-bearing; focus on swelling reduction and joint mobilization with physio
- Weeks 3–4: Boot with full weight-bearing, no crutches; continue physio for range of motion
- End of week 4: Transition to running shoes; begin strength and proprioception work with physio; swimming pool and static biking
- Week 5: Elliptical and cross trainer
- Weeks 6–7: Treadmill with interval walk-run training; pivoting and loading exercises
Note: If there is a significant cartilage defect alongside the ligament injury, impact activities are delayed until the three-month mark.
Recurring Ankle Sprains: Do Not Ignore Them
Patients with recurrent ankle sprains — or those with naturally lax ligaments — are at high risk of developing cartilage damage over time, especially if they are young or physically active. Dr. Gowreeson’s advice:
- First sprain: Ice, supportive footwear, anti-inflammatories. See a physiotherapist by week three to prevent recurrence.
- Two sprains in 6–12 months: Physiotherapy is essential to rebuild strength and stability.
- More than two sprains in 6–12 months: See an orthopedic specialist with a foot and ankle focus — cartilage damage may already be present, and earlier treatment leads to significantly better outcomes.
The Role of Physiotherapy at Every Stage
Whether or not surgery is required, physiotherapy is a cornerstone of ankle recovery. From reducing early swelling and preventing stiffness, to rebuilding strength, balance, and proprioception, and finally returning you to sport-specific conditioning — the Physioactive team is here to guide you at every step.
Don’t dismiss that rolled ankle. If symptoms persist beyond four weeks, or if this is not your first sprain, get it properly assessed.
Contact Physioactive today to speak with our team and start your recovery on the right foot.
