Sprained ankle

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.

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

• Ankle sprain can be graded for functional loss of function.:

Grading for functional loss of Ankle sprain
Grade	Degree of ligament damage	Symptoms 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

• 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.
• 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

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

For further information about the differential diagnosis, click here.

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".

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.

Gender

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

Race

• There is no racial predilection for ankle sprain.

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

• 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

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

• 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.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]

Physical Examination

• Patients with ankle sprain usually appear fine.
• Physical examination of a typical lateral ankle sprain may be remarkable for:

• Tenderness, swelling, and ecchymosis over anterior talofibuar and calcaneofibular ligaments. Swelling and bruising of the whole foot and toe may be demonstrated if no proper treatment has been applied and the patient has been ambulating.
• [finding 4]
• [finding 5]
• [finding 6]

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.
• Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Ultrasound

There are no ultrasound findings associated with ankle sprain.

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].

MRI

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

OR

[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].

OR

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].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[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].

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].

Treatment

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

• 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 sprains have been reported to have a high recurrence rate and may also lead to chronic ankle instability.

Related Chapters

• Sprain