Sprained ankle: Difference between revisions

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==Overview==
==Overview==
A sprained [[ankle]] is a common medical condition where one or more of the [[ligaments]] of the [[ankle]] is/are torn or partially 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.
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. Females are more commonly affected with an ankle [[sprain]] than males. The diagnosis of most [[ankle]] [[sprains]] is made in the light of [[history]] of acute [[ankle]] [[trauma]] and examination findings.  
 
==Historical Perspective==
*[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].
   
   
==Classification==
==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
 
:*[group1]
*[[Ankle]] [[sprain]] can be graded for functional loss of function<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>:
:*[group2]
 
:*[group3]
{| class="wikitable"
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
| colspan="3" align="center" style="background: #4479BA; color: #FFFFFF " |'''Grading for functional loss of Ankle sprain'''
|-
| align="center" |'''Grade'''
| align="center" |'''Degree of [[ligament]] damage'''
| align="center" |'''[[Symptom]]s and signs'''
|-
|'''Grade I'''
|Mild stretching
|
*[[Joint]] is stable and able to bear weight.
*Mild [[tenderness]] and [[swelling]].
|-
|'''Grade II'''
|Incomplete tear
|
*[[Joint]] is mild-moderately unstable with a mild range of motion restriction.
*[[Ecchymosis]], [[tenderness]], [[swelling]] and moderate [[pain]].
|-
|'''Grade III'''
|Complete tear
|
*[[Joint]] has remarkable mechanical instability with remarkable loss of function.
*[[Ecchymosis]], [[tenderness]], [[swelling]] and severe [[pain]].
|-
|}
 
==Pathophysiology==
==Pathophysiology==
[[Image:Ankle_ligament_injury.jpg|500px|thumb|right|Anterior Talofibular ligament injury on ultrasound. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 86361]]
*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 [[tibia|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.<ref name="pmid27042147">{{cite journal |vauthors=McGovern RP, Martin RL |title=Managing ankle ligament sprains and tears: current opinion |journal=Open Access J Sports Med |volume=7 |issue= |pages=33–42 |date=2016 |pmid=27042147 |pmc=4780668 |doi=10.2147/OAJSM.S72334 |url=}}</ref>
*The ATFL is the most commonly [[injury|injured]] structure with the lowest load to failure when compared to the other lateral [[ligament]]s. The anterior tallo[[fibula|fibular]] [[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 [[talus|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 [[plantarflexion|plantarflexed]] [[ankle]] undergoes [[supination]] and [[adduction]].<ref name="pmid32495041">{{cite journal |vauthors=Hur ES, Bohl DD, Lee S |title=Lateral Ligament Instability: Review of Pathology and Diagnosis |journal=Curr Rev Musculoskelet Med |volume=13 |issue=4 |pages=494–500 |date=August 2020 |pmid=32495041 |pmc=7340720 |doi=10.1007/s12178-020-09641-z |url=}}</ref>
*An [[ankle]] sprain can involve any of the following injuries:<ref name="urlLateral ankle sprain | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/lateral-ankle-sprain?lang=us#:~:text=Ankle%20ligament%20sprains%20can%20be,with%20swelling%20hematoma%20and%20pain |title=Lateral ankle sprain &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
**Anterior (and/or posterior) [[talofibular ligament]] [[injury]]
** [[Calcaneofibular ligament]] injury
**Possible [[peroneal tendon|peroneal]] and flexor [[tendon]] injuries
** Syndesmotic [[injury]]
*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]].<ref name="pmid22014912">{{cite journal |vauthors=Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E |title=Lateral and syndesmotic ankle sprain injuries: a narrative literature review |journal=J Chiropr Med |volume=10 |issue=3 |pages=204–19 |date=September 2011 |pmid=22014912 |pmc=3259913 |doi=10.1016/j.jcm.2011.02.001 |url=}}</ref>


*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
==Causes==
==Causes==
A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology.
A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology.


==Differentiating [disease name] from other Diseases==
==Differentiating [[ankle]] [[sprain]] from other Diseases==
 
* [[Ankle]] sprain should be differentiated from (click on the disease name to read more):<ref>{{cite book | last = Meyr | first = Andrew | title = Pain management | publisher = Elsevier Saunders | location = Philadelphia, Pa | year = 2008 | isbn = 1416063412 }}</ref>
For further information about the differential [[diagnosis]], click [[Disease_Name differential diagnosis|here]].
**[[Tendon]] [[pathologies]]: [[Achilles tendon rupture|Tendon rupture]], ITiFi [[ligament]] tear.
**[[Joint]] [[pathologies]]: [[Joint effusion]], and [[chronic osteoarthritis]].
**[[Fracture]]s: of the low [[fibula]], [[diaphysis|Diaphyseal]] [[fibula]], [[medial malleolus]], postmedial [[talus|talar]] process, anterior [[calcaneus|calcaneal]] process, os peronei, [[fifth metatarsal]],
** [[Microfractures]]: of the [[cuboid]], [[calcaneum]], and [[tibia]].
**[[Stress fracture]]
**[[Subluxation]]
**[[Impingement syndrome]], [[sinus tarsi syndrome]], [[tarsal tunnel syndrome]], [[Talus|Talar]] neck [[avulsion]], [[peroneal groove]] [[pathology]], [[peroneal nerve|peroneal]] [[tenosynovitis]].
**[[Muscle]]  [[pathologies]]: Split [[peroneus brevis]], [[peroneus longus]], [[tibialis anterior tear]], [[tibialis posterior dislocation]], and [[flexor digitorum brevis]] tear.


==Epidemiology and Demographics==
==Epidemiology and Demographics==


* The prevalence of [[ankle]] sprain is approximately [number or range] per 100,000 individuals worldwide. The most common [[injury|injuries]] suffered from during athletic/recreational activities is lateral [[ankle]] sprains.<ref name="pmid17513688">{{cite journal |vauthors=Fernandez WG, Yard EE, Comstock RD |title=Epidemiology of lower extremity injuries among U.S. high school athletes |journal=Acad Emerg Med |volume=14 |issue=7 |pages=641–5 |date=July 2007 |pmid=17513688 |doi=10.1197/j.aem.2007.03.1354 |url=}}</ref><ref name="pmid17710181">{{cite journal |vauthors=Hootman JM, Dick R, Agel J |title=Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives |journal=J Athl Train |volume=42 |issue=2 |pages=311–9 |date=2007 |pmid=17710181 |pmc=1941297 |doi= |url=}}</ref><ref name="pmid24198549">{{cite journal |vauthors=Hubbard TJ, Wikstrom EA |title=Ankle sprain: pathophysiology, predisposing factors, and management strategies |journal=Open Access J Sports Med |volume=1 |issue= |pages=115–22 |date=July 2010 |pmid=24198549 |pmc=3781861 |doi=10.2147/oajsm.s9060 |url=}}</ref>
*The prevalence of [[ankle]] sprain is approximately [number or range] per 100,000 individuals worldwide. The most common [[injury|injuries]] suffered from during athletic/recreational activities is lateral [[ankle]] sprains.<ref name="pmid17513688">{{cite journal |vauthors=Fernandez WG, Yard EE, Comstock RD |title=Epidemiology of lower extremity injuries among U.S. high school athletes |journal=Acad Emerg Med |volume=14 |issue=7 |pages=641–5 |date=July 2007 |pmid=17513688 |doi=10.1197/j.aem.2007.03.1354 |url=}}</ref><ref name="pmid17710181">{{cite journal |vauthors=Hootman JM, Dick R, Agel J |title=Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives |journal=J Athl Train |volume=42 |issue=2 |pages=311–9 |date=2007 |pmid=17710181 |pmc=1941297 |doi= |url=}}</ref><ref name="pmid24198549">{{cite journal |vauthors=Hubbard TJ, Wikstrom EA |title=Ankle sprain: pathophysiology, predisposing factors, and management strategies |journal=Open Access J Sports Med |volume=1 |issue= |pages=115–22 |date=July 2010 |pmid=24198549 |pmc=3781861 |doi=10.2147/oajsm.s9060 |url=}}</ref>
*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".<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*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".<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>


===Age===
===Age===
*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]].<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*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]].<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>


===Gender===
===Gender===
*A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle [[sprain]] than males.<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle [[sprain]] than males.<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
   
   
===Race===
===Race===
*There is no racial predilection for [[[ankle]] sprain.
 
*There is no racial predilection for [[ankle]] sprain.


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].


== Natural History, Complications and Prognosis==
*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.<ref name="pmid11273971">{{cite journal |vauthors=McKay GD, Goldie PA, Payne WR, Oakes BW |title=Ankle injuries in basketball: injury rate and risk factors |journal=Br J Sports Med |volume=35 |issue=2 |pages=103–8 |date=April 2001 |pmid=11273971 |pmc=1724316 |doi=10.1136/bjsm.35.2.103 |url=}}</ref>
*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 [#%].


== Diagnosis ==
==Natural History, Complications and Prognosis==
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
=== Symptoms ===
*[Disease name] is usually asymptomatic.
*Symptoms of [disease name] may include the following:
:*[symptom 1]
:*[symptom 2]
:*[symptom 3]
:*[symptom 4]
:*[symptom 5]
:*[symptom 6]
=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]


=== Laboratory Findings ===
*The majority of patients with [[ankle]] sprain may remain asymptomatic.
*There are no specific laboratory findings associated with [disease name].
*Early clinical features include [[tenderness]], [[swelling]], and [[ecchymosis]] over the [[anterior]] [[talofibular ligament|talofibuar]] and [[calcaneofibular ligament]]s. Although the [[patient]] may be asymptomatic depending upon the extent of [[injury]].
*If left untreated [[patients]] with [[ankle]] sprain may progress to develop balance problems due to [[proprioception]] deficits.  <ref name="pmid17436168">{{cite journal |vauthors=Akbari M, Karimi H, Farahini H, Faghihzadeh S |title=Balance problems after unilateral lateral ankle sprains |journal=J Rehabil Res Dev |volume=43 |issue=7 |pages=819–24 |date=2006 |pmid=17436168 |doi=10.1682/jrrd.2006.01.0001 |url=}}</ref>.
*Common complications of [[ankle]] sprain include chronic pain, joint instability, [[arthritis]].<ref name="pmid18346591">{{cite journal |vauthors=Martin B |title=Ankle sprain complications: MRI evaluation |journal=Clin Podiatr Med Surg |volume=25 |issue=2 |pages=203–47, vi |date=April 2008 |pmid=18346591 |doi=10.1016/j.cpm.2007.12.004 |url=}}</ref>
*Prognosis is generally good but [[acute]] ankle [[sprain]]s have been reported to have a high recurrence rate and may also lead to [[chronic]] ankle instability.<ref name="pmid31135209">{{cite journal |vauthors=Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA |title=Epidemiology of Ankle Sprains and Chronic Ankle Instability |journal=J Athl Train |volume=54 |issue=6 |pages=603–610 |date=June 2019 |pmid=31135209 |pmc=6602402 |doi=10.4085/1062-6050-447-17 |url=}}</ref>


*A  [positive/negative] [test name] is diagnostic of [disease name].
==Diagnosis==
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
===Diagnostic Criteria===
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Electrocardiogram===
There are no ECG findings associated with [disease name].


OR
*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]].<ref name="pmid29514819">{{cite journal |vauthors=Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ |title=Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline |journal=Br J Sports Med |volume=52 |issue=15 |pages=956 |date=August 2018 |pmid=29514819 |doi=10.1136/bjsports-2017-098106 |url=}}</ref><ref name="pmid27042147">{{cite journal |vauthors=McGovern RP, Martin RL |title=Managing ankle ligament sprains and tears: current opinion |journal=Open Access J Sports Med |volume=7 |issue= |pages=33–42 |date=2016 |pmid=27042147 |pmc=4780668 |doi=10.2147/OAJSM.S72334 |url=}}</ref>


An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Symptoms===


===X-ray===
*[[Acute]] [[injury|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.<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
There are no x-ray findings associated with [disease name].


OR
===Physical Examination===


An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*Patients with [[ankle]] sprain usually appear fine. But, the [[patient]] may be in distress depending upon the intensity of [[pain]].
*Physical examination of a typical [[lateral]] [[ankle]] [[sprain]] may be remarkable for:


OR
:*[[Tenderness]], [[swelling]], and [[ecchymosis]] over [[anterior]] [[talofibular ligament|talofibuar]] and [[calcaneofibular ligament]]s. [[Swelling]] and [[bruise|bruising]] of the whole [[foot]] and [[toe]] may be demonstrated if no proper treatment has been applied and the [[patient]] has been [[ambulating]].<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
:*The [[patient]] should be assessed for the degree of instability, site, [[pain]] intensity, and an evaluation of neurovascular status.<ref>{{cite book | last = Meyr | first = Andrew | title = Pain management | publisher = Elsevier Saunders | location = Philadelphia, Pa | year = 2008 | isbn = 1416063412 }}</ref>


There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Laboratory Findings===


===Echocardiography or Ultrasound===
*There are no specific laboratory findings associated with [[ankle]] sprain.
There are no echocardiography/ultrasound  findings associated with [disease name].


OR
===Electrocardiogram===
*There are no ECG findings associated with [[ankle]] sprain.


Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===X-ray===


OR
*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 [[Medial malleolus|malleolar]] or mid[[foot]] region, or [[tenderness]] of the [[bone]] over the potential [[fracture]] region, or [[weight]] bearing inability for four steps right after the [[injury]] warrants [[radiography]].<ref name="pmid12595378">{{cite journal |vauthors=Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G |title=Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review |journal=BMJ |volume=326 |issue=7386 |pages=417 |date=February 2003 |pmid=12595378 |pmc=149439 |doi=10.1136/bmj.326.7386.417 |url=}}</ref><ref name="pmid19187397">{{cite journal |vauthors=Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB |title=Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis |journal=Acad Emerg Med |volume=16 |issue=4 |pages=277–87 |date=April 2009 |pmid=19187397 |doi=10.1111/j.1553-2712.2008.00333.x |url=}}</ref>
*Lateral, anteroposterior, and mortise views of the [[ankle]] help visualize the lesion.


There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Ultrasound===
*Ultrasound findings include thickening and [[hypoechogenicity]] of the affected [[ligament]] demonstrate a [[sprain]].<ref name="urlLateral ankle sprain | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/lateral-ankle-sprain?lang=us#nav_radiographic-features |title=Lateral ankle sprain &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR


There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*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.<ref name="urlLateral ankle sprain | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/lateral-ankle-sprain?lang=us#nav_radiographic-features |title=Lateral ankle sprain &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>


===MRI===
===MRI===
There are no MRI findings associated with [disease name].


OR
*An [[ankle]] MRI may be helpful for ankle injuries involving [[crepitus]] or locking, as these [[symptoms]] may indicate a displaced osteochondral fragment.<ref name="pmid11195774">{{cite journal |vauthors=Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC |title=Management of ankle sprains |journal=Am Fam Physician |volume=63 |issue=1 |pages=93–104 |date=January 2001 |pmid=11195774 |doi= |url=}}</ref>
*An [[MRI]] may help identify syndesmosis [[sprain]]s and [[peroneal]] [[tendon]] involvement.<ref name="pmid10416542">{{cite journal |vauthors=Lazarus ML |title=Imaging of the foot and ankle in the injured athlete |journal=Med Sci Sports Exerc |volume=31 |issue=7 Suppl |pages=S412–20 |date=July 1999 |pmid=10416542 |doi=10.1097/00005768-199907001-00002 |url=}}</ref>


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
==Treatment==


OR
*Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step.<ref name="pmid21655420">{{cite journal |vauthors=Lin CW, Hiller CE, de Bie RA |title=Evidence-based treatment for ankle injuries: a clinical perspective |journal=J Man Manip Ther |volume=18 |issue=1 |pages=22–8 |date=March 2010 |pmid=21655420 |pmc=3103112 |doi=10.1179/106698110X12595770849524 |url=}}</ref> Brace, tape, elastic bandage, or soft cast are preferred over immobilization.<ref name="pmid12137710">{{cite journal |vauthors=Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN |title=Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD003762 |date=2002 |pmid=12137710 |doi=10.1002/14651858.CD003762 |url=}}</ref>  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).<ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>
*Cold therapy for 12 to 20 minutes together with compression until the [[swelling]] settles or 48 hours, is found to be helpful.<ref name="pmid2712981">{{cite journal |vauthors=Sloan JP, Hain R, Pownall R |title=Clinical benefits of early cold therapy in accident and emergency following ankle sprain |journal=Arch Emerg Med |volume=6 |issue=1 |pages=1–6 |date=March 1989 |pmid=2712981 |pmc=1285549 |doi=10.1136/emj.6.1.1 |url=}}</ref><ref name="pmid2334279">{{cite journal |vauthors=Airaksinen O, Kolari PJ, Miettinen H |title=Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains |journal=Arch Phys Med Rehabil |volume=71 |issue=6 |pages=380–3 |date=May 1990 |pmid=2334279 |doi= |url=}}</ref><ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>
*Severe ankle sprains should be assessed by an [[orthopedic]] specialist, although [[physical therapy]] is extremely effective for most sprained [[ankle]]s.
*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.<ref name="pmid14527076">{{cite journal |vauthors=Eisenhart AW, Gaeta TJ, Yens DP |title=Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries |journal=J Am Osteopath Assoc |volume=103 |issue=9 |pages=417–21 |date=September 2003 |pmid=14527076 |doi= |url=}}</ref><ref name="pmid11276181">{{cite journal |vauthors=Green T, Refshauge K, Crosbie J, Adams R |title=A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains |journal=Phys Ther |volume=81 |issue=4 |pages=984–94 |date=April 2001 |pmid=11276181 |doi= |url=}}</ref><ref name="pmid15040966">{{cite journal |vauthors=Collins N, Teys P, Vicenzino B |title=The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains |journal=Man Ther |volume=9 |issue=2 |pages=77–82 |date=May 2004 |pmid=15040966 |doi=10.1016/S1356-689X(03)00101-2 |url=}}</ref><ref name="pmid21655420">{{cite journal |vauthors=Lin CW, Hiller CE, de Bie RA |title=Evidence-based treatment for ankle injuries: a clinical perspective |journal=J Man Manip Ther |volume=18 |issue=1 |pages=22–8 |date=March 2010 |pmid=21655420 |pmc=3103112 |doi=10.1179/106698110X12595770849524 |url=}}</ref>


There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
===Medical Therapy===


===Other Imaging Findings===
*[[NSAIDS]] are helpful for [[analgesia]] (both [[oral]] or [[topical]] are effective).<ref name="pmid20556778">{{cite journal |vauthors=Massey T, Derry S, Moore RA, McQuay HJ |title=Topical NSAIDs for acute pain in adults |journal=Cochrane Database Syst Rev |volume= |issue=6 |pages=CD007402 |date=June 2010 |pmid=20556778 |pmc=4163964 |doi=10.1002/14651858.CD007402.pub2 |url=}}</ref><ref name="pmid1864448">{{cite journal |vauthors=Morán M |title=Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains |journal=J Int Med Res |volume=19 |issue=2 |pages=121–30 |date=1991 |pmid=1864448 |doi=10.1177/030006059101900205 |url=}}</ref><ref name="pmid29514819">{{cite journal |vauthors=Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ |title=Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline |journal=Br J Sports Med |volume=52 |issue=15 |pages=956 |date=August 2018 |pmid=29514819 |doi=10.1136/bjsports-2017-098106 |url=}}</ref>
There are no other imaging findings associated with [disease name].


OR
===Surgery===


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
*Surgical repair can be performed for [[patient]]s 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.<ref name="pmid12793557">{{cite journal |vauthors=Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN |title=Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial |journal=J Bone Joint Surg Br |volume=85 |issue=4 |pages=525–30 |date=May 2003 |pmid=12793557 |doi=10.1302/0301-620x.85b4.13928 |url=}}</ref>


=== Other Diagnostic Studies ===
===Prevention===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Effective measures for the primary prevention of the [[ankle]] [[sprain]] include warming up before the sports.
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].


==Treatment==
==Related Chapters==
Severe ankle sprains should be assessed by an [[orthopedic]] specialist although [[physical therapy]] treatment is extremely effective for most sprained ankles.
*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, elevate).
*An [[ankle]] brace can be very helpful for the treatment and prevention of a sprained [[ankle]] [[injury]]. [[Crutches]] and air-braces while conventionally used, are currently out of vogue. Complete [[immobilization]] is currently the most preferred option among specialists in the form of the plastic [[casts]] also known as a walker. It gives the leg an exercise and yet keeps the damaged part from moving.


=== Medical Therapy ===
*[[Sprain]]
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
=== Prevention ===
*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].
 
==Prognosis==
*[[Acute]] ankle [[sprain]]s have been reported to have a high recurrence rate and may also lead to [[chronic]] ankle instability.<ref name="pmid31135209">{{cite journal |vauthors=Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA |title=Epidemiology of Ankle Sprains and Chronic Ankle Instability |journal=J Athl Train |volume=54 |issue=6 |pages=603–610 |date=June 2019 |pmid=31135209 |pmc=6602402 |doi=10.4085/1062-6050-447-17 |url=}}</ref>
 
==Related Chapters==
* [[Sprain]]


==References==
==References==

Latest revision as of 00:01, 25 March 2021

Sprained ankle
Lateral view of the human ankle

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Synonyms and keywords: Ankle sprain; ankle injury; ankle ligament injury

Overview

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. Females are more commonly affected with an ankle sprain than males. The diagnosis of most ankle sprains is made in the light of history of acute ankle trauma and examination findings.

Classification

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

Pathophysiology

File:Ankle ligament injury.jpg
Anterior Talofibular ligament injury on ultrasound. Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 86361

Causes

A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology.

Differentiating ankle sprain from other Diseases

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.[7][8][9]
  • 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".[10]

Age

  • 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.[10]

Gender

  • A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle sprain than males.[10]

Race

  • There is no racial predilection for ankle sprain.

Risk Factors

  • 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.[11]

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Symptoms

Physical Examination

  • Patients with ankle sprain usually appear fine. But, the patient may be in distress depending upon the intensity of pain.
  • Physical examination of a typical lateral ankle sprain may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with ankle sprain.

Electrocardiogram

  • There are no ECG findings associated with ankle sprain.

X-ray

  • 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.[17][18]
  • Lateral, anteroposterior, and mortise views of the ankle help visualize the lesion.

Ultrasound

CT scan

  • 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.[4]

MRI

Treatment

  • Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step.[21] Brace, tape, elastic bandage, or soft cast are preferred over immobilization.[22] 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).[23]
  • Cold therapy for 12 to 20 minutes together with compression until the swelling settles or 48 hours, is found to be helpful.[24][25][23]
  • 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.[26][27][28][21]

Medical Therapy

Surgery

  • 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.[31]

Prevention

  • Effective measures for the primary prevention of the ankle sprain include warming up before the sports.

Related Chapters

References

  1. ↑ 1.0 1.1 1.2 Tiemstra JD (June 2012). "Update on acute ankle sprains". Am Fam Physician. 85 (12): 1170–6. PMID 22962897.
  2. ↑ 2.0 2.1 McGovern RP, Martin RL (2016). "Managing ankle ligament sprains and tears: current opinion". Open Access J Sports Med. 7: 33–42. doi:10.2147/OAJSM.S72334. PMC 4780668. PMID 27042147.
  3. ↑ Hur ES, Bohl DD, Lee S (August 2020). "Lateral Ligament Instability: Review of Pathology and Diagnosis". Curr Rev Musculoskelet Med. 13 (4): 494–500. doi:10.1007/s12178-020-09641-z. PMC 7340720 Check |pmc= value (help). PMID 32495041 Check |pmid= value (help).
  4. ↑ 4.0 4.1 4.2 "Lateral ankle sprain | Radiology Reference Article | Radiopaedia.org".
  5. ↑ Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E (September 2011). "Lateral and syndesmotic ankle sprain injuries: a narrative literature review". J Chiropr Med. 10 (3): 204–19. doi:10.1016/j.jcm.2011.02.001. PMC 3259913. PMID 22014912.
  6. ↑ Meyr, Andrew (2008). Pain management. Philadelphia, Pa: Elsevier Saunders. ISBN 1416063412.
  7. ↑ Fernandez WG, Yard EE, Comstock RD (July 2007). "Epidemiology of lower extremity injuries among U.S. high school athletes". Acad Emerg Med. 14 (7): 641–5. doi:10.1197/j.aem.2007.03.1354. PMID 17513688.
  8. ↑ Hootman JM, Dick R, Agel J (2007). "Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives". J Athl Train. 42 (2): 311–9. PMC 1941297. PMID 17710181.
  9. ↑ Hubbard TJ, Wikstrom EA (July 2010). "Ankle sprain: pathophysiology, predisposing factors, and management strategies". Open Access J Sports Med. 1: 115–22. doi:10.2147/oajsm.s9060. PMC 3781861. PMID 24198549.
  10. ↑ 10.0 10.1 10.2 Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C (January 2014). "The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies". Sports Med. 44 (1): 123–40. doi:10.1007/s40279-013-0102-5. PMID 24105612.
  11. ↑ McKay GD, Goldie PA, Payne WR, Oakes BW (April 2001). "Ankle injuries in basketball: injury rate and risk factors". Br J Sports Med. 35 (2): 103–8. doi:10.1136/bjsm.35.2.103. PMC 1724316. PMID 11273971.
  12. ↑ Akbari M, Karimi H, Farahini H, Faghihzadeh S (2006). "Balance problems after unilateral lateral ankle sprains". J Rehabil Res Dev. 43 (7): 819–24. doi:10.1682/jrrd.2006.01.0001. PMID 17436168.
  13. ↑ Martin B (April 2008). "Ankle sprain complications: MRI evaluation". Clin Podiatr Med Surg. 25 (2): 203–47, vi. doi:10.1016/j.cpm.2007.12.004. PMID 18346591.
  14. ↑ Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA (June 2019). "Epidemiology of Ankle Sprains and Chronic Ankle Instability". J Athl Train. 54 (6): 603–610. doi:10.4085/1062-6050-447-17. PMC 6602402 Check |pmc= value (help). PMID 31135209.
  15. ↑ 15.0 15.1 Vuurberg G, Hoorntje A, Wink LM, van der Doelen B, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman M, Ridderikhof ML, Smithuis FF, Stufkens S, Verhagen E, de Bie RA, Kerkhoffs G (August 2018). "Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline". Br J Sports Med. 52 (15): 956. doi:10.1136/bjsports-2017-098106. PMID 29514819. Vancouver style error: initials (help)
  16. ↑ Meyr, Andrew (2008). Pain management. Philadelphia, Pa: Elsevier Saunders. ISBN 1416063412.
  17. ↑ Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G (February 2003). "Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review". BMJ. 326 (7386): 417. doi:10.1136/bmj.326.7386.417. PMC 149439. PMID 12595378.
  18. ↑ Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB (April 2009). "Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis". Acad Emerg Med. 16 (4): 277–87. doi:10.1111/j.1553-2712.2008.00333.x. PMID 19187397.
  19. ↑ Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC (January 2001). "Management of ankle sprains". Am Fam Physician. 63 (1): 93–104. PMID 11195774.
  20. ↑ Lazarus ML (July 1999). "Imaging of the foot and ankle in the injured athlete". Med Sci Sports Exerc. 31 (7 Suppl): S412–20. doi:10.1097/00005768-199907001-00002. PMID 10416542.
  21. ↑ 21.0 21.1 Lin CW, Hiller CE, de Bie RA (March 2010). "Evidence-based treatment for ankle injuries: a clinical perspective". J Man Manip Ther. 18 (1): 22–8. doi:10.1179/106698110X12595770849524. PMC 3103112. PMID 21655420.
  22. ↑ Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN (2002). "Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults". Cochrane Database Syst Rev (3): CD003762. doi:10.1002/14651858.CD003762. PMID 12137710.
  23. ↑ 23.0 23.1 van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM (2012). "What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?". J Athl Train. 47 (4): 435–43. doi:10.4085/1062-6050-47.4.14. PMC 3396304. PMID 22889660.
  24. ↑ Sloan JP, Hain R, Pownall R (March 1989). "Clinical benefits of early cold therapy in accident and emergency following ankle sprain". Arch Emerg Med. 6 (1): 1–6. doi:10.1136/emj.6.1.1. PMC 1285549. PMID 2712981.
  25. ↑ Airaksinen O, Kolari PJ, Miettinen H (May 1990). "Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains". Arch Phys Med Rehabil. 71 (6): 380–3. PMID 2334279.
  26. ↑ Eisenhart AW, Gaeta TJ, Yens DP (September 2003). "Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries". J Am Osteopath Assoc. 103 (9): 417–21. PMID 14527076.
  27. ↑ Green T, Refshauge K, Crosbie J, Adams R (April 2001). "A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains". Phys Ther. 81 (4): 984–94. PMID 11276181.
  28. ↑ Collins N, Teys P, Vicenzino B (May 2004). "The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains". Man Ther. 9 (2): 77–82. doi:10.1016/S1356-689X(03)00101-2. PMID 15040966.
  29. ↑ Massey T, Derry S, Moore RA, McQuay HJ (June 2010). "Topical NSAIDs for acute pain in adults". Cochrane Database Syst Rev (6): CD007402. doi:10.1002/14651858.CD007402.pub2. PMC 4163964. PMID 20556778.
  30. ↑ Morán M (1991). "Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains". J Int Med Res. 19 (2): 121–30. doi:10.1177/030006059101900205. PMID 1864448.
  31. ↑ Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN (May 2003). "Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial". J Bone Joint Surg Br. 85 (4): 525–30. doi:10.1302/0301-620x.85b4.13928. PMID 12793557.


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