UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Ankle sprain

Author
Karen L Maughan, MD
Section Editors
Patrice Eiff, MD
Francis G O'Connor, MD, MPH, FACSM
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Ankle injuries are among the most common injuries presenting to primary care offices and emergency departments [1]. 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 [2]. 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.

                              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Oct 25 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Boruta PM, Bishop JO, Braly WG, Tullos HS. Acute lateral ankle ligament injuries: a literature review. Foot Ankle 1990; 11:107.
  2. Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med 2005; 39:e14; discussion e14.
  3. Nitz AJ, Dobner JJ, Kersey D. Nerve injury and grades II and III ankle sprains. Am J Sports Med 1985; 13:177.
  4. Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med 2007; 35:1197.
  5. Taylor DC, Englehardt DL, Bassett FH 3rd. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med 1992; 20:146.
  6. Trojian TH, McKeag DB. Ankle sprains: expedient assessment and management. Physician and Sportsmedicine 1998; 26:10. www.physsportsmed.com/issues/1998/10Oct/mckeag.htm (Accessed on June 10, 2005).
  7. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001; 35:103.
  8. Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med 2013; 47:620.
  9. van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br 1996; 78:958.
  10. Frost SC, Amendola A. Is stress radiography necessary in the diagnosis of acute or chronic ankle instability? Clin J Sport Med 1999; 9:40.
  11. Nikken JJ, Oei EH, Ginai AZ, et al. Acute ankle trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment. Radiology 2005; 234:134.
  12. Brand DA, Frazier WH, Kohlhepp WC, et al. A protocol for selecting patients with injured extremities who need x-rays. N Engl J Med 1982; 306:333.
  13. Brooks SC, Potter BT, Rainey JB. Inversion injuries of the ankle: clinical assessment and radiographic review. Br Med J (Clin Res Ed) 1981; 282:607.
  14. Dunlop MG, Beattie TF, White GK, et al. Guidelines for selective radiological assessment of inversion ankle injuries. Br Med J (Clin Res Ed) 1986; 293:603.
  15. Lloyd S. Selective radiographic assessment of acute ankle injuries in the emergency department: barriers to implementation. CMAJ 1986; 135:973.
  16. Sujitkumar P, Hadfield JM, Yates DW. Sprain or fracture? An analysis of 2000 ankle injuries. Arch Emerg Med 1986; 3:101.
  17. Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA 1993; 269:1127.
  18. Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326:417.
  19. Sloan JP, Hain R, Pownall R. Clinical benefits of early cold therapy in accident and emergency following ankle sprain. Arch Emerg Med 1989; 6:1.
  20. Hocutt JE Jr, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. Am J Sports Med 1982; 10:316.
  21. Morán M. Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains. J Int Med Res 1991; 19:121.
  22. Slatyer MA, Hensley MJ, Lopert R. A randomized controlled trial of piroxicam in the management of acute ankle sprain in Australian Regular Army recruits. The Kapooka Ankle Sprain Study. Am J Sports Med 1997; 25:544.
  23. Massey T, Derry S, Moore RA, McQuay HJ. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev 2010; :CD007402.
  24. van den Bekerom MP, Sjer A, Somford MP, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events. Knee Surg Sports Traumatol Arthrosc 2015; 23:2390.
  25. Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull 2011; 97:105.
  26. Kerkhoffs GM, Rowe BH, Assendelft WJ, et al. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2002; :CD003762.
  27. Jones MH, Amendola AS. Acute treatment of inversion ankle sprains: immobilization versus functional treatment. Clin Orthop Relat Res 2007; 455:169.
  28. Lamb SE, Marsh JL, Hutton JL, et al. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet 2009; 373:575.
  29. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician 2001; 63:93.
  30. Wester JU, Jespersen SM, Nielsen KD, Neumann L. Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study. J Orthop Sports Phys Ther 1996; 23:332.
  31. Verhagen E, van der Beek A, Twisk J, et al. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med 2004; 32:1385.
  32. McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006; 34:1103.
  33. Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ 2010; 340:c1964.
  34. Weinstein ML. An ankle protocol for second-degree ankle sprains. Mil Med 1993; 158:771.
  35. Feger MA, Herb CC, Fraser JJ, et al. Supervised rehabilitation versus home exercise in the treatment of acute ankle sprains: a systematic review. Clin Sports Med 2015; 34:329.
  36. Refshauge KM, Raymond J, Kilbreath SL, et al. The effect of ankle taping on detection of inversion-eversion movements in participants with recurrent ankle sprain. Am J Sports Med 2009; 37:371.
  37. Janssen KW, van Mechelen W, Verhagen EA. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. Br J Sports Med 2014; 48:1235.
  38. Pijnenburg AC, Van Dijk CN, Bossuyt PM, Marti RK. Treatment of ruptures of the lateral ankle ligaments: a meta-analysis. J Bone Joint Surg Am 2000; 82:761.
  39. Kerkhoffs GM, Handoll HH, de Bie R, et al. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev 2007; :CD000380.
  40. Pijnenburg AC, Bogaard K, Krips R, et al. Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. J Bone Joint Surg Br 2003; 85:525.
  41. van den Bekerom MP, van der Windt DA, Ter Riet G, et al. Therapeutic ultrasound for acute ankle sprains. Cochrane Database Syst Rev 2011; :CD001250.
  42. de Bie RA, de Vet HC, Lenssen TF, et al. Low-level laser therapy in ankle sprains: a randomized clinical trial. Arch Phys Med Rehabil 1998; 79:1415.
  43. Bennett M, Best TM, Babul S, et al. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane Database Syst Rev 2005; :CD004713.
  44. Moraes VY, Lenza M, Tamaoki MJ, et al. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 2013; :CD010071.
  45. Konradsen L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports 2002; 12:129.
  46. Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport 2015; 18:238.
  47. van Ochten JM, van Middelkoop M, Meuffels D, Bierma-Zeinstra SM. Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments. J Orthop Sports Phys Ther 2014; 44:862.
  48. Hall EA, Docherty CL, Simon J, et al. Strength-training protocols to improve deficits in participants with chronic ankle instability: a randomized controlled trial. J Athl Train 2015; 50:36.
  49. Faizullin I, Faizullina E. Effects of balance training on post-sprained ankle joint instability. Int J Risk Saf Med 2015; 27 Suppl 1:S99.
  50. Cruz-Diaz D, Lomas-Vega R, Osuna-Pérez MC, et al. Effects of 6 Weeks of Balance Training on Chronic Ankle Instability in Athletes: A Randomized Controlled Trial. Int J Sports Med 2015; 36:754.
  51. van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 2008; 121:324.
  52. Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. Int J Sports Phys Ther 2014; 9:583.
  53. Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med 2010; 44:1082.
  54. Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport 2010; 13:309.
  55. McGuine TA, Hetzel S, Wilson J, Brooks A. The effect of lace-up ankle braces on injury rates in high school football players. Am J Sports Med 2012; 40:49.
  56. McGuine TA, Brooks A, Hetzel S. The effect of lace-up ankle braces on injury rates in high school basketball players. Am J Sports Med 2011; 39:1840.
  57. Burks RT, Bean BG, Marcus R, Barker HB. Analysis of athletic performance with prophylactic ankle devices. Am J Sports Med 1991; 19:104.
  58. Grimm NL, Jacobs JC Jr, Kim J, et al. Ankle Injury Prevention Programs for Soccer Athletes Are Protective: A Level-I Meta-Analysis. J Bone Joint Surg Am 2016; 98:1436.