Ankle Sprains: Surgery vs Physiotherapy – What You Need to Know
Ankle sprains are one of the most common injuries seen in active people, from weekend walkers to professional athletes. They can happen in an instant — a quick twist, an uneven surface, or a misstep on the sports field — and suddenly your ankle is swollen and painful.
While many people recover well with physiotherapy, others may wonder whether surgery is the better option. Let’s break down what actually happens when you sprain your ankle, how the severity is classified, and when surgery might be necessary.
What Is an Inversion Ankle Sprain and How Does It Happen?
Most ankle sprains occur through an inversion mechanism, meaning the foot turns inward unexpectedly. This overstretches the lateral ligaments on the outside of the ankle — mainly the anterior talofibular ligament (ATFL), and sometimes the calcaneofibular ligament (CFL).
Inversion sprains often occur during activities that involve jumping, quick changes in direction, or uneven surfaces — such as basketball, soccer, trail running, or even stepping off a curb the wrong way.
When the ligaments are stretched beyond their limits, tiny fibres can tear. This leads to pain, swelling, and sometimes instability in the ankle joint. Most sprains heal well with proper rehabilitation, but severe or poorly managed injuries can lead to long-term problems such as chronic instability or recurrent sprains.
The Different Grades of Ankle Sprains
Ankle sprains are classified into three grades, depending on the severity of ligament damage:
Grade I (Mild)
A slight stretching of the ligament with microscopic tears. There’s mild tenderness and swelling, and you can usually still walk with minimal discomfort.Grade II (Moderate)
A partial tear of the ligament. You’ll notice moderate pain, swelling, bruising, and some difficulty putting weight on the ankle. There may be mild looseness in the joint.Grade III (Severe)
A complete tear of one or more ligaments. Swelling and bruising are significant, walking is very painful or impossible, and the ankle may feel unstable or “give way.” These are the sprains that sometimes raise the question of surgery vs conservative care.
Surgery vs Physiotherapy: Which and When?
The good news is that most ankle sprains do not need surgery. Even many severe (Grade III) sprains recover well with structured physiotherapy and early rehabilitation.
Conservative (non-surgical) treatment is almost always the first line of care. This includes protecting the ankle, reducing swelling, restoring movement, and progressively strengthening and retraining balance.
Surgery is generally reserved for specific situations, such as:
Chronic ankle instability that doesn’t improve after 3–6 months of rehab
Severe ligament tears that cause ongoing “giving way” despite treatment
High ankle (syndesmotic) sprains with proven instability on imaging
Associated fractures or large bone or cartilage fragments
Elite athletes who need a faster return to high-level sport
For most people, surgery offers no better long-term outcomes than physiotherapy — and carries added risks such as infection, stiffness, or nerve irritation. That’s why evidence-based guidelines recommend trying a full course of physiotherapy before considering surgical options.
What’s Involved in Physiotherapy for Ankle Sprains?
Physiotherapy focuses on early movement and functional rehabilitation, which helps ligaments heal while maintaining strength and flexibility. A typical program includes several phases:
1. Acute Phase (Days 1–3)
The priority is to protect the ankle, reduce swelling, and control pain. Treatment usually follows the POLICE principles — Protection, Optimal Loading, Ice, Compression, and Elevation. Crutches or a supportive boot may be used briefly for comfort, but prolonged rest is discouraged.
2. Early Rehabilitation (Days 3–10)
Gentle movement begins as soon as pain allows. Exercises may include ankle circles, calf stretches, or tracing the alphabet with your foot. Early movement prevents stiffness and promotes faster healing.
3. Strengthening and Balance (Weeks 2–6)
As swelling subsides, strengthening exercises target the calf and peroneal muscles to support the ankle. Balance training (such as single-leg stands or wobble board exercises) retrains the stabilising muscles that prevent future sprains.
4. Functional and Sport-Specific Training (Weeks 6–12)
For active individuals, the final phase includes hopping, cutting, and agility drills to prepare for a safe return to sport. Bracing or taping during high-risk activities can help protect the healing ligaments.
Recovery time depends on severity:
Grade I: 1–3 weeks
Grade II: 3–6 weeks
Grade III: 8–12 weeks (sometimes longer)
With consistent rehab, most people regain full strength and stability without surgery. Physiotherapy not only treats the current sprain but also helps prevent recurrence — a key goal, since up to 40% of people who sprain an ankle experience another injury later on.
What’s Involved in Surgery for Ankle Sprains?
Surgery for ankle sprains is typically reserved for chronic or complex cases. There are a few main approaches, but the goal is to restore stability by repairing or reconstructing damaged ligaments.
A common procedure is the Broström repair, which tightens and reattaches the torn ligaments on the outside of the ankle. In more complex cases, synthetic materials or tendon grafts may be used to strengthen the repair.
If a syndesmotic (high ankle) injury is present, screws or suture-button devices may be inserted to stabilise the joint while the ligaments heal.
Recovery After Surgery
Immobilisation: 2–6 weeks in a boot or cast
Rehabilitation: Begins once the surgeon allows movement, focusing on regaining range of motion, strength, and balance
Return to activity: Often around 4–6 months, depending on the extent of repair
Although surgical repair can be successful, especially in athletes or severe instability cases, recovery is typically longer than with physiotherapy and carries more risks.
For most people, structured non-surgical rehabilitation provides equal or better outcomes without the downtime of surgery.
Prognosis and Long-Term Outlook
With the right management, the outlook for ankle sprains is excellent. Most people return to normal activity within weeks to months, depending on severity.
However, incomplete rehab or returning to sport too early can lead to recurrent sprains or chronic instability, which may eventually require surgical intervention.
That’s why early physiotherapy and a graduated return-to-activity plan are essential — not only to heal but to protect the ankle’s long-term function.
At Novar Sports Physio, we help people recover from ankle sprains every day — from first-time injuries to chronic instability. Our evidence-based approach focuses on restoring strength, stability, and confidence, so you can get back to the activities you love safely and quickly.
If you’ve recently sprained your ankle or are still struggling with pain and instability, book an appointment today. Early rehabilitation makes all the difference in long-term recovery.
Disclaimer: Our articles are not designed to replace medical advice. If you have an injury or health concern, we recommend seeing a qualified health professional.
