Ankle twisted - what should be done?


The twisting of the foot, or rather the ankle, is one of the absolute everyday injuries. Often it just happens when you stumble or while exercising. Women who wear heeled shoes are also more likely to lose their balance.

Often you straighten up without any pain or discomfort, but every now and then a twisted foot can be quite painful. The following article deals with the causes, symptoms and treatment options for a twisted foot.

Anatomical basics

To understand what the Buckling of the foot happens exactly, it is important to know a few simple anatomical basics. The foot is about that Ankle joint connected to the lower leg. The ankle joint consists roughly of one upper and one lower anklethat of numerous ribbons secured. The upper ankle is in direct connection with the Shin (Tibia).

Important Tapes are these Outer band (Ligamentum collaterale laterale), which actually consists of three individual bands. These three bands are called L.igamentum talofibulare anterius, ligamentum talofibulare posterius and Calcaneofibular ligament. Inside the ankle is the so-called "Delta band"(also called inner band) secured. This delta band also consists of several individual bands and pulls from the inner ankle to the sole of the foot.

It is important to know these anatomical foundations as it is they that are injured when the foot is twisted.


When exercising, it quickly happens that you twist your foot. The foot should then be quickly cooled and protected.

But why does the foot bend in the first place? The foot can be very easy by a wrong move, for example during sport or in everyday life, twist ankle.

There is also Factors who favor that. For one, can high heels lead to instabilities in the ankle and a reduced balance in movement and thus cause an ankle twist.

But also one shortened calf muscles favors twisting. Likewise is one weak shin muscles not conducive. The calf muscles pull the foot in and down, whereas the shin muscles here as Opponent works. An imbalance can lead to the ankle bending slightly inwards. This will be the most common Outer ligament injured.

The most common injury when twisting the foot is the so-called Supination trauma. The outer band is damaged to varying degrees. It can only be one Overstretching of the capsule and ligament structures exist. Individual fibers tear, but the tape as such remains as a whole. One then speaks of a distortion. However, in more severe cases, it does Torn ligaments.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Illustration of a buckled foot

Illustration of the bent foot: right foot from the side, from the front and possible therapeutic measures

foot bend over

  1. Outer ankle
    (Fibula bone) -
    Lateral malleolus
  2. Anterior fibula-talus
    Tape -
    Talofibular ligament anterius
  3. Posterior fibula-talus
    Tape -
    Posterior talofibular ligament
  4. Fibula-calcaneus
    Tape -
    Calcaneofibular ligament
  5. Upper ankle joint -
    Articulatio talocruralis
  6. Lower ankle joint -
    Articulatio talocalcaneonavicularis
  7. Calf community - Corpus fibulae
  8. Inner ankle
    (Shin bones) -
    Medial malleolus
  9. Delta band
    = Inner sideband -
    Medial collateral ligament
    (Ligamentum deltoideum)

    I - supination of the foot -
    Outward rotation
    II - pronation of the foot -
    Inward rotation
    P - pause
    (The joint should be spared)
    E - ice cream
    (Cool ankle)
    C - compression
    (Apply compression bandage)
    H - Elevate
    (Raise affected foot -
    relieves pain and swelling)
    Ointments with low molecular weight heparin
    Homeopathy -
    Preparations (chamomile, buttercup, arnica)

You can find an overview of all Dr-Gumpert images at: medical illustrations


If you actually injured yourself while twisting your ankle, for example a torn ligament or overstretching, this can be a very painful affair.

In the acute phase of the injury, the joint is painful and swollen. It can also be reddened. Ruptured blood vessels can cause a larger or smaller hematoma, which makes the ankle blue and swollen after a few days. This bruise is then typically on the outside of the ankle, just below the ankle. Stepping on the affected foot hurts, but it is still possible with pain.

If ligaments are torn or extensive ligament injuries have occurred, those affected feel insecure and unstable on their feet. In very pronounced cases, if the outer ligament ruptures, the joint can be folded in beyond its natural extent.

Also read: Bump on foot

Swelling of the foot

Even if there is pain and swelling, there does not necessarily have to be a serious injury. In some cases, twisting the foot has no serious consequences. But there next Ligament stretching (see also: Ligament stretch at the ankle) and torn ligaments (see also: Torn ligament foot) fractures can also occur, the incident must usually first be taken seriously and, if necessary, clarified by a doctor.
If the affected foot or ankle swells a lot after the twisting, a ligament injury should be assumed first. This includes ligament strains and incomplete and complete ligament tears. In addition to the damage to the ligament itself, this also occurs Damage to the surrounding tissue and as a result, a local flow of fluid that causes the injured limb to swell.
If blood vessels are also injured, the foot can become dislocated spreading Bruise, slowly turn bluish. Since fluid and blood in the vicinity of the anatomical structures of the ankle and foot have very little space to spread, it soon increases Tension or pressure pain, which usually has a dull, pulsating character.
For the medical layperson, it is usually not immediately recognizable whether a swollen foot has a disease that requires treatment. The doctor will also contact you if necessary Use x-ray to rule out bony injuries. On the physical examination, pain from passive movement of the injured limb does not always provide information about the type of injury. The examination can be made even more difficult by the swelling.
In order to keep the swelling and the associated pain as low as possible, you should react immediately after the injury occurs. The affected foot must be spared immediately and any further burden avoided become. Cool packs can decrease fluid influx and bleeding, thereby reducing the amount of swelling. The same goes for one Compression bandagewhich is applied carefully but with enough force in an ascending direction. The affected foot should also stored high become. Heparin ointments (see also: Heparin) can help reduce existing bruises more quickly. In any case, the injury should be presented to a doctor, who can rule out the consequences of the injury and, if necessary, initiate further treatment.

You might also be interested in: swollen ankles

Instep pain

Pain on the back of the foot (instep) is common Signs of chronic illness like the Ankle arthrosis (see also: Osteoarthritis, ankle arthrosis) and in most cases due to prolonged exposure.
It is not uncommon for a sore back of the foot to have one Foot malposition underlying.
However, if pain on the instep only occurs after a foot injury, a Injury to the so-called Chopart joint or the Lisfranc joint line be considered. The Chopart joint exists between the ankle and calcaneus on one side and two tarsal bones (navicular and cubic bone) on the other. The Lisfranc joint line lies between the tarsal bones and the metatarsals. Both joints are held together by tight band-like connections and can hardly be moved.
In the event of a large force being exerted, this can be cushioned by the low mobility of the joint components. If the occurring forces are too great, the ligament connections of these very tightly connected joints can tear. In particular, injuries to the Lisfranc joint line are often overlooked during the examination. The result can be chronic and difficult-to-treat pain on the back of the foot.

Pain on the outside

Pain on the outside of the foot is after twisting the foot not necessarily typical. However, as already mentioned, the skeleton of the foot is held together by tight ligaments that can tear when subjected to heavy loads.
Not all of these ligaments hold bony components. Some also direct the tendons of the muscles that originate further up the leg. These tendons can be exposed to great forces when twisted. Torn ligaments on the outside of the foot can cause local pain there. In some cases a so-called Avulsion fracture (Avulsion fracture). A torn ligament tears out parts of the bone in which it is anchored.
Also Damage to the nerves can cause pain in the foot. The deep calf nerve, in medical terminology Deep peroneal nerve (see also: Peroneal nerve) called, extends from the calf to the outside of the foot. If the ankle swells after an injury, this nerve can be compressed in its course and cause pain and abnormal sensations.
A Fracture of the fifth metatarsal (see also: Metatarsal fracture) could also cause pain on the outside of the foot. This injury, which is relatively rare by comparison, is more likely to occur in athletes in the context of chronic overload.

Pain in the ankle

Pain and swelling after twisting the foot are most impressive in the ankle area. There are a multitude of bony structures, ligaments, tendons and nerves that can be damaged and cause discomfort.
The distended ends of the tibia and fibula represent the bony components of the ankle joint. Both bones are connected above the ankle joint by a tight connective tissue membrane, the interosseous membrane, and in the area of ​​the ankle joint by strong ligaments, also known as syndesmosis tibiofibularis.
If you twist your foot, it can become too Fractures on different levels of the two lower leg bones come. At the level of the ankle there is a fracture according to the so-called Weber classification judge. One speaks of a Weber fracture, which is divided into three locations. A fracture below the syndesmosis tibiofibularis, i.e. below the strong ligamentous connections, is called a Weber A fracture. If the bone is broken at the level of the syndesmosis, it is referred to as a Weber B fracture and a fracture above the syndesmosis is referred to as a Weber C fracture. In the latter, the interosseous membrane is also torn in most cases. They usually cause broken bones severe pain, misalignment and swelling. A X-ray examination helps to investigate the suspicion of a break.
In order to keep the bony structures of the ankle in shape and to give the tendons of the muscles their course, the individual components are strengthened Tapes fixed. This can be in the context of an injury are overstretched, partially tearing or completely tearing. If there is a stretched ligament, the affected ankle usually swells. Increasing pain in the ankle area is the result. Torn ligaments are often from massive swelling and bruising accompanied. In any case, a doctor should be consulted.
Important ones run in the ankle area Nerves and nerve branches of the lower leg and the foot. These include the tibial nerve (Nervus tibialis) and the fibula nerves. As a result of bone fractures, there can be damage and thus to Pain, sensory disturbances and dysfunction come below the injury.

Pain in the calf

Pain in the calf can definitely relate to one Ligament stretch or one Torn ligament be due. They do not always have to occur immediately after the accident. Patients sometimes report of slowly increasing calf pain even days after the injury occurred. One of the reasons for this may be a permanent increase in the muscle tension of the calf muscles, which occurs because of the pain in the ankle area and because of the involuntary relieving posture of the affected extremity. However, increasing calf pain should always be presented to the attending physician, as there is also a dangerous one behind it Leg vein thrombosis (see also: thrombosis) can hide. Symptoms such as Redness, swelling and feeling of pressure.

Late pain

In the context of ankle injuries after twisting the foot, swelling of the injured extremity usually occurs. Depending on the severity of the injury, it can be more or less severe.
One is typical slow increase in swelling, as a result of which the Intensify pain. This is due to the fact that the anatomical structures in the area of ​​the ankle joint have little space and the pressure on them increases with increasing swelling. It comes to Compression of muscles, blood vessels and nerves. This can cause pain later or worsen existing pain. The injured person can try to reduce the swelling Immobilization, elevation, and cooling of the injured foot as well as the Applying compression bandages to keep it low. The increase in pain can usually be effectively prevented in this way.


Usually the doctor can already go through that Conversation with the patient and the physical examination of the ankle joint determine whether the twisting of the foot becomes a Ligament injury has led.

At a Supination trauma shows a Swelling and tenderness of the joint. Also, as mentioned earlier, there is a Hematoma seen on the outside of the ankle.

If the Outer bands in the sense of a Torn ligament injured, a so-called "lateral opening“In the joint. That means that you have the ankle joint compared to the lower leg move outwards can. However, this examination may also be impossible due to pain. If the anterior portion of the outer ligament (Talofibular anterior ligament) is torn, the ankle can be clearly seen Forward advance (Talar advancement). At a strain or Overextension Is not that the case.

The examinations are always in Side comparison performed. This is important because everyone's ankle has one different agility and so anomalies can only be reliably identified by comparing the sides.

Also the imaging procedures are used in diagnostics. X-rays in two levels are done by default to Injuries to the bony structures to exclude. These accompanying injuries include the Weber fractures. Hold x-rays are used when there is uncertainty about the stability of the ankle.

The MRI Usually only used when more extensive injuries have to be diagnosed more precisely. However, this is usually not the case with a simple twisting of the foot.


There are a few things you can do immediately after you twist your foot before consulting a doctor. The so-called PECH rules are followed:

  1. P: The joint should be spared immediately after the event, so you take a break (P).
  2. E: Then you should cool the ankle joint (E = ice). This will reduce both the swelling and the pain. However, the cold pack should not be placed directly on the affected ankle, as this can cause cold damage.
  3. C: In order to reduce the swelling even more effectively, it is advisable to apply a compression bandage (C =Compression).
  4. H: The last thing you should do is raise the affected foot (H). This will lower the static blood pressure on the injured ankle and relieve pain and swelling.

In the case of simple strains and distortions, these decongestant measures are usually sufficient.

Ligament ruptures are usually treated conservatively with the above measures. In addition, the joint is secured with special splints or bandages (Orthotics) so that the ligaments can grow back together well under less stress. The joint is not completely immobilized, but still has room to move.

Simple movement exercises and physical therapy are also recommended to promote joint mobility. These braces are worn for approximately 6 weeks. Painkillers and anti-inflammatories can also be taken. That depends on the severity of the pain.

To get rid of the bruise faster, ointments with low molecular weight heparin are also used. This also serves as a thrombosis prophylaxis.

In the case of more serious injuries, e.g. complicated tears of the capsule and ligament, or bone fractures, surgical interventions may also be necessary. These take place in different ways, depending on which structure is affected. Among other things, plastic reconstructions of the ligament apparatus, ligament sutures, but also other methods are used to restore the bony structures. The duration of treatment is between a few weeks and months.

Surgical measures are usually only considered in the event of severe injuries or existing joint instability despite long conservative therapy. So if after 6 weeks of physiotherapy and splinting the joint the affected person still kinks, an operation may be necessary.

In professional and competitive athletes, an operation may sometimes be necessary earlier in order to ensure full performance again. However, these are individual decisions.


Serious injuries cannot be ruled out when twisting the foot. In the event of pain and swelling, a consultation with a doctor should take place. Primary homeopathic treatment is strongly discouraged.
However, those who do not want to take pain medication can treat the symptoms with the measures explained above, such as immobilization, cooling, compression and elevation. Homeopathy also offers numerous preparations that are used to treat pain. These include chamomile, buttercup and arnica.

You might also be interested in: Home remedies for swollen ankles

Child's foot twisted

It happens quickly when jumping from the playground equipment, when playing in the school yard or in physical education. Ankle injuries are among the most common injuries in children and adolescents. In principle, the same bony structures, ligaments and nerves can be damaged as in adults.
Swelling and pain in the injured extremity should always be taken seriously in the child and presented to a pediatrician or an orthopedic surgeon. Children are not always able to provide precise information about the type of pain or how the accident happened. It is all the more important that the injury is examined and assessed by experienced medical personnel.
Fractures in the growing bones in particular, if overlooked or not properly treated, can cause long-term damage such as chronic pain or malpositions. The main problem here is when the bone fracture affects the growth plate.
In the area of ​​the ankle, doctors use the Salter and Harris classification to classify the extent of the damage to the growth plate and to design the therapy accordingly. Although X-ray technology is used sparingly in paediatrics because of the radiation exposure, the doctor will use imaging techniques here to prevent late damage.
Pain and swelling of an injured foot must therefore always be examined by a doctor in children. In the context of pain therapy, the same means are available as for adults. Immobilization, cooling, compression and elevation help to contain the symptoms. Pain medications approved for children are ibuprofen and paracetamol.

For more information, see: childish fracture