|Lateral view of the human ankle|
WikiDoc Resources for Sprained ankle
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Synonyms and Keywords: Ankle sprain; ankle injury; ankle ligament injury
A sprained ankle is a common medical condition where one or more of the ligaments of the ankle is/are stretched, partially or completely torn. Ankle sprains are more common among physically active individuals. The anterior talofibular ligament is one of the most commonly involved ligaments. Sprains to the lateral aspect of the ankle account for 85% of ankle sprains.
- [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
- In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
- In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
|Grading for functional loss of Ankle sprain|
|Grade||Degree of ligament damage||Symptoms and signs|
|Grade I||Mild stretching|
|Grade II||Incomplete tear|
|Grade III||Complete tear|
- The pathogenesis of ankle sprain is characterized by ankle movement beyond the elastic limits of its supporting structures causing acute ankle pathology.
- Lateral ankle sprain injury is usually caused by forefoot adduction, hindfoot inversion, and tibial external rotation with ankle in plantar flexion. Depending on the amount and direction of the force, one or more of the lateral ligaments can be involved.
- The ATFL is the most commonly injured structure with the lowest load to failure when compared to the other lateral ligaments. The anterior tallofibular ligament (ATFL) is the most commonly injured ligament and is most susceptible to injury during ankle plantarflexion with the ankle's bony anatomy providing less stability. In this position, ATFL acts as a collateral ligament to the ankle. The ATFL prevents talar internal rotation, anterior translation and is a restraint to plantarflexion. The most common mechanism of injury to the ATFL is inversion injury where a plantarflexed ankle undergoes supination and adduction.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, microscopic failure of the collagen fibers characterize ankle sprain when the load and velocity applied to outweigh the mechanical strength of the ligament and speed of a corrective muscle reflex.
A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology.
- Ankle sprain should be differentiated from (click on the disease name to read more):
Epidemiology and Demographics
- The prevalence of ankle sprain is approximately [number or range] per 100,000 individuals worldwide. The most common injuries suffered from during athletic/recreational activities is lateral ankle sprains.
- The indoor/court sports has a "cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h".
- A systematic review and meta-analyses of prospective studies reported that children compared with adolescents and adults are more likely to sustain an ankle sprain.
- A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle sprain than males.
- There is no racial predilection for ankle sprain.
- A study describing the common risk factors for development of ankle sprain among recreational basketball players reported having a previous history of ankle injury, wearing shoes with air cells in the heel, and not stretching before the game to be the common risk factors.
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
- The diagnosis of most ankle sprains is made in the light of history of acute ankle trauma and examination findings. Diagnostic imaging is unnecessary although ultrasound may help assess the extent of tendon injury.
- Acute injuries may not demonstrate any signs and symptoms. Ask the patient to describe injury mechanism. Most sprains involve ankle inversion with some plantar flexion and suggest lateral ligament injury. Another mechanism, such as dorsiflexion, eversion suggest some other ligament involvement.
- Other symptoms of ankle aprain may include the following:
- [symptom 1]
- [symptom 2]
- Patients with ankle sprain usually appear fine.
- Physical examination of a typical lateral ankle sprain may be remarkable for:
- There are no specific laboratory findings associated with ankle sprain.
- There are no ECG findings associated with ankle sprain.
- An x-ray may be helpful in the diagnosis of ankle sprain. The Ottawa criteria (100% sensitivity) helps indicate of the radiography is indicated. According to the criteria, in case of pain in the malleolar or midfoot region, or tenderness of the bone over the potential fracture region, or weight bearing inability for four steps right after the injury warrants radiography.
- Lateral, anteroposterior, and mortise views of the ankle help visualize the lesion.
- Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
- Ultrasound findings include thickening and hypoechogenicity of the affected ligament demonstrate a sprain.
- CT scan may be helpful in the diagnosis of ankle sprain. Findings on CT scan suggestive of sprain include thickening, thinning, irregularity, discontinuity, or an absent ligament. Sometimes bony avulsions can be visible.
- An ankle MRI may be helpful for ankle injuries involving crepitus or locking, as these symptoms may indicate a displaced osteochondral fragment.
- An MRI may help identify syndesmosis sprains and peroneal tendon involvement.
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
- Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step. Brace, tape, elastic bandage, or soft cast are preferred over immobilization. It gives the leg an exercise and yet keeps the damaged part from moving. Crutches and air-braces while conventionally used, are currently out of vogue.
- Immediately following the injury it is important the follow the PRICE protocol – Protection, Rest, Ice, Compression, and Elevation (also known as RICE: Rest, Ice, Compress, and Elevate).
- Cold therapy for 12 to 20 minutes together with compression until the swelling settles or 48 hours, is found to be helpful.
- Severe ankle sprains should be assessed by an orthopedic specialist, although physical therapy is extremely effective for most sprained ankles.
- The evidence of use of ultrasound, LASER, and manual therapy (such as anteroposterior glide of the talus, Mulligan’s mobilization with movement, chiropractic mortise adjustment technique) for reducing swelling and pain is at various levels.
- Surgical repair can be performed for patients with ruptured ankle ligaments. Operative treatment has been shown to have a better long-term outcome for residual pain, recurrent sprains and stability in a randomised clinical trial.
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
- Acute ankle sprains have been reported to have a high recurrence rate and may also lead to chronic ankle instability.
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