- Karen L Maughan, MD
Karen L Maughan, MD
- Associate Professor of Family Medicine
- University of Virginia
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
Ankle injuries are among the most common injuries presenting to primary care offices and emergency departments . Patients with ankle sprains (stretching, partial rupture, or complete rupture of at least one ligament) constitute a large percentage of these injuries.
Ankle ligaments provide mechanical stability, proprioceptive information, and directed motion for the joint. Recurrent ankle sprains can lead to functional instability and loss of normal ankle kinematics and proprioception, which can result in recurrent injury, chronic instability, early degenerative bony changes, and chronic pain . Acute ankle sprains can result in lost days of work and inability to participate in sports.
Ankle sprains will be reviewed here. Ankle fractures are discussed separately. (See "Overview of ankle fractures in adults".)
CLASSIFICATION OF ANKLE SPRAINS
Location — The mechanism of injury generally determines the location of the sprain (figure 1).
Lateral ankle sprain — The most common mechanism of ankle injury is inversion of the plantar-flexed foot (figure 2), which causes damage to the lateral ligament complex of the ankle. This ligament complex consists of the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament (figure 3). The ligaments within this complex are injured in a predictable sequence as forces increase.
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- CLASSIFICATION OF ANKLE SPRAINS
- - Lateral ankle sprain
- - Medial ankle sprain
- - Syndesmotic sprain (high ankle sprain)
- CLINICAL EVALUATION
- Physical examination
- Special tests
- - Squeeze test
- - External rotation stress test
- - Anterior drawer test
- - Talar tilt test
- Deferred examination
- Imaging modality
- Selection of patients
- - Ottawa ankle rules
- Immediate therapy
- - Approach and exercises
- - Splints and braces
- Ultrasound and other proposed therapies
- Chronic ankle instability
- INDICATIONS FOR REFERRAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS