Heard this a million times. What we have always trained our staff at FFLC is to take the Ankle and Foot films in these cases. The reason is that most ankle sprains are just that, sprains of ankle ligaments. BUT foot fractures due to twisting of the ankle is more common than ankle fractures.
- Fifth metatarsal base fractures
5th metatarsal base fracture 
Surgical fix with screw. - Anterior process calcaneal fractures
- Jones' Fractures.
- Lis Franc's fracture / dislocations
I know the last one personally. I twisted my foot during Brazilian Jujitsu practice and immediately my foot and ankle swelled up. Being a foot / ankle doctor, the treatment that night consisted of ICE, rest and ace wrap, the next morning Xrays were taken. Luckily, no fractures but I did have a lis franc's sprain which has taken up to 6 months to get me back to 90 % of my physical activity.
So when you think of ankle sprains now, think, check the foot!
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