Ankle Sprains in the Workers’ Compensation System: Trends, Costs, and Predictors of High-Expense Claims: A 9-Year Analysis

OBJECTIVES: To evaluate trends, costs, and predictors of high-cost ankle sprain claims in the workers' compensation system. METHODS: Among 26,773 ankle injury claims (2016-2024), 18,991 sprains were identified and analyzed using descriptive and analytical multivariate methods. RESULTS: Sprains comprised about 70% of all ankle injuries, with increasing proportions among medical-only claims during the 9 years. Litigation, some comorbidities (diabetes and thyroid conditions), and coexisting injuries were strongly associated with high-cost claims (≥$50,000). Sprains without coexisting injuries represented 82.2% of medical-only and 65.1% of lost-time cases, with average costs of $1331 and $25,593, respectively, whereas those with coexisting injuries averaged $2451 and $53,942. CONCLUSIONS: Ankle sprains impose a substantial and underrecognized workers' compensation burden among ankle injuries. Litigation, some comorbidities, and injury complications are key predictors of high-cost outcomes.