Ankle Sprains : Why They Are More Serious Than You Think

Ankle sprains, as Dr Gowreeson Thevendran explains, are far more serious than most patients realise. Many treat a rolled ankle with ice and carry on. But Dr Gowreeson, orthopaedic surgeon at Island Orthopedic Clinic Singapore, warns that this approach can lead to long-term damage — 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 breaks down what really happens during an ankle sprain, when to seek help, and how surgery and physiotherapy get you back on your feet.

Why Ankle Sprains Are Often Underestimated

The common assumption is that an ankle sprain only affects ligaments. In reality, depending on the force of injury, other structures can also be damaged — specifically bone, cartilage, or tendons.

When these are involved alongside a ligament injury, recovery becomes significantly more complex. Left untreated, some injuries result in chronic pain, instability, or permanent disability.

Dr Gowreeson sees approximately 8 to 10 ankle sprains every week. He notes a growing trend: an aging, more active population is presenting later with consequences of sprains that were never properly managed.

Red Flags: When Is an Ankle Sprain 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 worsen 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 these are visible on a standard X-ray. According to research published on PubMed, undiagnosed cartilage injuries after ankle sprains are a leading cause of chronic ankle pain in active adults.

How Dr Gowreeson Assesses Ankle Sprains

The most critical factor is how quickly the patient presents after injury.

Within 48 hours: The priority is to reduce inflammation and protect the ankle. Treatment includes a walker boot, crutches for 7–10 days, 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. This is when physiotherapy at PhysioActive begins.

Later presentations (2–8 weeks post-injury): If the ankle is still painful and swollen, immobilisation 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 Does Dr Gowreeson Recommend Surgery for Ankle Sprains?

Thanks to advances in minimally invasive techniques over the last 5–10 years, ankle ligament surgery now uses small keyhole incisions and 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
• 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

Studies published in the Journal of Orthopaedic Surgery and Research confirm that arthroscopic repair of ankle ligaments produces excellent functional outcomes with low complication rates.

The Recovery Timeline: Week by Week

Dr Gowreeson provides one of the most detailed recovery roadmaps available:

• Weeks 1–2: Boot and crutches; no weight-bearing; focus on swelling reduction and joint mobilisation 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; swimming 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 significant cartilage damage 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. 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 orthopaedic specialist — cartilage damage may already be present. Earlier treatment leads to significantly better outcomes.

The Role of Physiotherapy in Ankle Sprain Recovery

Whether or not surgery is required, physiotherapy is a cornerstone of ankle recovery. From reducing early swelling to rebuilding strength, balance, and proprioception — and finally returning to sport-specific conditioning — structured rehabilitation makes the difference between a full recovery and a chronic problem.

Our team at PhysioActive guides you at every stage of recovery. Do not dismiss that rolled ankle. If symptoms persist beyond four weeks, or if this is not your first sprain, get it properly assessed before it becomes a long-term issue.

Ready to Explore Your Treatment Options?

Dr. Gowreeson Thevendran
Orthopaedic Surgeon, Singapore
Island Orthopedic Clinic
Website: https://iog.com.sg/
Tel: +65 6356 0588

PhysioActive Singapore
Website: https://physioactive.sg/
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PhysioActive Indonesia
Website: https://www.physioactive.id/
Locations in Jakarta: Darmawangsa, Setiabudi, and Sunter
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