Ankle sprain

Background

• Ankle stabilization:
  • Medial: Medial collateral (deltoid) ligament (tibia to talus and calcaneus)
  • Lateral: Anterior/posterior talofibular, calcaneofibular ligaments
    • Weaker than medial ligament; more commonly injured in sprains

Diagnosis

• Anterior drawer test
  • Tests anterior talofibular ligament
  • Cup heel w/ 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

1. Class I
   1. mild pain,swelling can bear weight, negative stress test-
   2. Treatment = RICE and f/u in 7 days.
2. Class II
   1. mod pain, swelling, difficulty bearing weight, pos ant drawer (4-14 mm), pos talar tilt (5-15 degrees)
   2. Treatment: rigid splint, crutches, <7 day f/u.
3. Class III
   1. severe pain, unable to bear weight, lot of swelling. ant drawer >15 mm, talar tilt >15 degrees
   2. Treatment: rigid splint, crutches, f/u in <7 days.

Eversion injuries- deltoid ligament rarely isolated tear-usually avulsion Fx of medial malleolus. syndesmotic sprains more common than deltoid injuries (and more easily missed).

Grade 2 and 3 eversion injuries are often placed in a short leg walking cast for 6-8 weeks.

Causes of Chronic Pain after Healing

1. soft tissue problems
   1. synovial impingement syndromes
   2. loose bodies in the joint
   3. proneal tendon subluxation
2. bony problems
   1. osteochondral Fx of talar dome
   2. lateral or posterior fx of talus
   3. anterior fx of calcaneus

Syndesmotic Sprain

(High Ankle)

Diagnosis

1. Positive squeeze test
2. TTP distal tibiofibular joint

Treatment

1. Treat as sprain, f/u ortho/sports
2. possible surgical repair if refractory to conservative management

See Also

• Ankle Fracture
• Ankle Fracture (Peds)
• Maisonneuve
• Ottowa Ankle Rules
• Pilon Fx