Top 3 strategies to avoid ankle sprains

illustration of a foot showing how an ankle sprain can occur, as described in the article

Consider yourself lucky if you've never sprained your ankle. The injury is extremely common — occurring as often as 25,000 times per day in the United States — and it can happen at any age, whether you're playing sports or you just happen to take a misstep.

Warding off an ankle sprain and the potential trouble it brings — such as pain, weeks of recovery, and increased risks for recurring sprains, impaired balance, and falls — is a priority to maintain your mobility and independence. Here are three approaches to help you keep your ankles strong, flexible, and healthy.

Ankle sprain basics

The ankle is a hinge made up of the ends of the lower leg bones—the tibia and fibula—and the talus bone in the foot. Strong bands of fibrous tissue called ligaments help bind the bones together and stabilize the ankle, keeping the joint from moving too far in any direction. Ligaments work in concert with powerful muscles in the calf so you can stand, walk, climb, or jump on smooth or uneven surfaces.

The ankles also support and distribute your weight so you can maintain your balance.

An ankle sprain occurs when you overstretch or tear the ligaments in the joint. This happens most often when the foot is accidentally forced on its side. If the foot rolls onto or lands on its outer side (with its sole facing inward), the ligaments on the outer side of the ankle can be injured. This is called an inversion sprain—by far the most common type of sprain. If the foot rolls onto or lands on its inner side (with its sole facing out), the ligaments on the inner side of the ankle can be sprained (an eversion sprain).

If the foot is twisted or rotated outward too far, typically during contact sports, the ligaments that join the leg bones just above the talus bone can be sprained (a syndesmotic or "high" ankle sprain).

1. Strengthen the calf muscles

One essential way to ward off ankle sprains is to strengthen the muscles that support it in the calf: the gastrocnemius and soleus muscles. They not only help propel you forward, but also allow you to flex your foot.

The best way to beef up these muscles is by doing heel raises: rise up onto the balls of your feet for a moment, and then lower your heels to the ground, about 10 times in a row (see "Moves of the month").

But don't take a gingerly approach. "One of the top mistakes we see is that people don't challenge their ankles enough," says Kevin McEnroy, a physical therapist at Harvard-affiliated Brigham and Women's Hospital. "These muscles are strong — capable of handling forces about two times your body weight. They need the appropriate stresses to get them even stronger."

Instead of doing calf raises on two legs at a time, McEnroy recommends trying them on one leg at a time. "On two legs, each calf is lifting only half of your body weight. But the calves can do much more than that. Work your way up to doing calf raises on one leg at a time while holding on to a counter or the back of a chair," he says.

To challenge your ankle even more, hold a weight in one hand during a single-leg calf raise (on the same side as the leg you're strengthening). For example, if you do single calf raises with your left leg, hold a weight in your left hand and keep your right hand on a counter or chair for balance. Your trainer or physical therapist can help you determine the right amount of weight to lift.

2. Strengthen side movement

Two groups of muscles in the ankle are responsible for side-to-side movement: the invertors, which twist the toes of your foot inward (toward your other foot); and the evertors, which twist the toes of your foot outward (away from you). To better stabilize your ankles, you need to strengthen invertors and evertors regularly.

At home, you can strengthen these muscles using a loop resistance band. Slip one end of the band around the leg of a sturdy table, and slip the other end around the midsection of your foot. Move your foot to the left of the table leg until the band becomes taut. With your heel planted firmly on the floor, turn your foot away from the table as far as you can, then return to the starting position. Repeat 10 times. Then place your foot to the right of the table leg and repeat the exercise, again turning your foot away from the table leg as far as you can. Then try the exercise with your other foot.

If you exercise at the gym, ask a trainer to show you how to use a piece of equipment called a cable column to perform similar exercises.

3. Stretch the calf muscles

You must stretch the calf muscles regularly to keep them healthy. A standard calf stretch (extending one leg back, pressing that leg's heel against the floor, and keeping that heel in place while leaning toward a wall) helps the upper calf muscles stay long and flexible.

But to avoid ankle sprains, McEnroy says the stretch that will really count is in the lower calves, where the calf muscles connect to the ankles. For that, do a soleus stretch (see "Moves of the month") by putting your hands on a wall, taking a step back with one foot, and bending both knees until you feel a stretch in the lower part of the calf behind you. "Having flexibility at the bottom of the calves will get your knee out farther over your foot or toes. That reduces your risk of a sprain," McEnroy says. "If you stretch regularly, you might be able to prevent that."

Moves of the month

Heel raises

photo showing a woman performing the heel raise exercise as described in the article

Stand up straight with your feet hip-width apart and your hands at your sides. Hold on to a chair if you need support. Slowly lift your heels off the floor as high as possible, balancing on the balls of your feet. Pause, then slowly return to the starting position. Repeat 10 times.

Soleus stretch

photo of a woman performing the soleus stretch exercise as described in the article

Stand up straight in front of a wall with your arms extended at shoulder height, hands on the wall. Place your right foot a few inches behind your left foot and press the heel into the floor, bending your knees slightly as you do so, feeling a stretch in the lower calf of your right leg. Hold 10 to 30 seconds. Return to the starting position. Repeat on the other leg.