Understanding How We Grade Your Sprained Ankle

Understanding How We Grade Your Sprained Ankle

Ankle sprains are common injuries among people of all ages. In fact, data indicate that about two million ankle sprains are medically treated every year in the United States. Aside from pain in and around the joint, ankle sprains can cause swelling, bruising, and impaired mobility.

At Rocky Mountain Foot & Ankle, our team provides patient-centered treatment for ankle sprains, beginning with an evaluation and grading of your injury. Here’s what those grades mean and why we grade sprains in the first place.

Grading basics

Your ankle is made up of bones, muscles, and other tissues, including tough bands called ligaments. These ligaments connect the bones that make up your ankle joint. An ankle sprain happens when one or more of these ligaments is stretched beyond its normal limits, sometimes tearing away from the bone.

Grade one sprains

Ankle sprains are graded from one to three based on the severity of the sprain. A grade one sprain is the mildest type of sprain, occurring when the ligaments are stretched with either no ligament tissue damage or very minimal damage. These sprains are associated with mild  tenderness, swelling, and stiffness.

Grade two sprains

Grade two is the next level of sprain. This sprain involves partial tears of the ligaments — for instance, a tear that extends halfway across the ligament while leaving the other half attached to the bone. Grade two sprains are tender to the touch and cause a fair amount of pain when walking, although the joint still feels relatively stable.

Grade three sprains

Grade three ankle sprains are the most severe type of sprain. These injuries happen when one or more ligaments are torn all the way across, detaching the ligament from the bone. These sprains cause intense pain, severe swelling, and bruising. With a grade three sprain, your ankle will be very unstable and unable to bear weight.

How and why we grade ankle sprains

Like other musculoskeletal injuries, ankle sprains require different types of treatment depending on the severity of the injury. Grading provides your doctor with information that can help guide appropriate care to help the area heal.

To determine the grade, we begin with an examination of the ankle, taking note of visible signs of injury as well as the degree of pain and instability you’re experiencing. Diagnostic imaging helps rule out fractures, which can cause similar symptoms.

Once we assign a grade to your sprain, we design a treatment plan to help relieve pain, restore function, and heal the ligament injury. While most patients benefit from over-the-counter anti-inflammatory medicines to relieve both pain and swelling, the other steps of treatment vary, depending on the grade of the sprain.

Grade one

Grade one sprains can be treated with rest, ice, compression, and elevation (also called RICE therapy). Applying ice for 20-30 minutes several times a day helps reduce inflammation. Elevating the leg can reduce swelling, too. We may recommend a compression bandage to provide additional joint support.

Grade two

Grade two sprains also benefit from RICE therapy, but these sprains require a brace or splint to stabilize the joint and provide support as well. A crutch or cane may be necessary to help you stay mobile, although you should try to stay off the ankle as much as possible

Grade three

Grade three sprains require extra stabilization with either a brace or a cast. For younger patients or athletic people, we may recommend surgery to repair the ligament and prevent chronic ankle instability that increases your risk of future sprains.

Get help for your ankle sprain

If you have a mild-to-moderate sprain, it can be tempting to treat it on your own. But delaying medical care can increase your risk of developing chronic instability that can lead to future sprains and more serious complications.


If you have an ankle sprain or any type of ankle pain, don’t ignore it. Call 303-423-2520, or request an appointment online at our locations in Wheat Ridge, Granby, Evergreen, Arvada, and Thornton, Colorado, today.

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