Ligaments in the ankle and/or foot become injured usually from abnormal twisting motions causing pain and difficulty walking. Sometimes there can be a fracture of the ankle or metatarsal(s) bones depending on severity. X-rays are typically taken to rule out a broken bone. The actual ligaments are invisible on x-ray. MRI is the best method to evaluate the ligaments and tendons associated with a severe ankle sprain. Rarely do ankle sprains require surgery.