Ankle sprain

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Background

Ankle stabilization anatomy

  • Syndesmosis
  • Ligaments
    • Medial: Medial collateral (deltoid) ligament (tibia to talus and calcaneus)
    • Lateral: Anterior/posterior talofibular, calcaneofibular ligaments

Clinical Features

Lateral Ankle Sprain

  • Most common
  • Due to inversion of plantarflexed ankle
  • Anterior talofibular ligament (ATFL) is most commonly injured ligament

Medial Ankle Sprain

  • Isolated sprain is unusual; often associated with fibular fracture or syndesmosis injury
  • Always rule-out Maisonneuve fracture by evaluating proximal fibula

Syndesmotic Sprain ("High-ankle sprain")

  • Assoc with hyperdorsiflexion when talus moves superiorly and separates tibia/fibula
  • Pain just above talus

Differential Diagnosis

Other Ankle Injuries

Distal Leg Fractures

Foot and Toe Fractures

Hindfoot

Midfoot

Forefoot

Evaluation

  • Anterior drawer test
    • Tests anterior talofibular ligament
    • Cup heel with one hand and and pull anteriorly while pushing tibia posteriorly
  • Talar tilt test
    • Tests for combined injury of anterior talofibular and calcaneofibular ligaments
    • Inversion at the ankle causes tilting/lifting of the mortise joint

Classification

  • Grade I
    • No tearing of ligaments
    • Minimal pain, swelling, ecchymosis; weightbearing is tolerable
    • No splinting/casting; weight bearing as tolerated, isometric exercises, full ROM and stretching/strengthening exercises
  • Grade II
    • Partial ligament tear; possible instability
    • Increased pain, swelling, ecchymosis; difficulty bearing weight
    • Immoblize with air splint; PT with ROM/stretching/strengthening exercises
  • Grade III
    • Complete ligament tear; significant instability
    • Severe pain, swelling, ecchymosis; inability to bear weight
    • Immobilization and possible surgery; PT same as grade 2 but longer time period

Management

  • Stable joint and ability to bear weight:
    • NSAIDs, RICE (rest, ice, compression, elevation)
    • 1 week follow up if no improvement
  • Stable joint but unable to bear weight:
    • Ankle brace with follow up in 1wk
  • Unstable joint

Disposition

  • Discharge

See Also

References