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Ankle Sprain

Ankle sprains are one of the most common injuries sustained during recreational and competitive sports such as soccer, basketball, football, and running. Although a common injury, many individuals do not seek medical attention and are self-treated. Depending on the extent of the injury, inadequate treatment of an ankle sprain may lead to chronic pain, decreased range of motion, or instability. In addition, a self-diagnosed ankle sprain may actually be a more severe injury, such as a fracture at or distal to the ankle complex.

Every year, there are 1 to 2 million cases of ankle sprain, constituting 15% to 20% of all sports-related injuries. Of all types of ankle injuries, 75% to 85% are ankle sprains, with the majority of them caused by an ankle inversion injury. Approximately 40% of ankle sprains can lead to chronic injury.

There are a number of contributing factors that may predispose an individual to sustain an ankle sprain, which can include the following:

  • Previous history of ankle sprain/injury
  • Older individuals who are sedentary
  • Overweight individuals/obesity
  • “Weekend warriors,” who do not train/engage in sports actively and consistently
  • Type and frequency of sport that involves more stress on the ankle complex

Anatomy

The ankle is a type of hinge joint. This joint is formed by the articulation of three bones: the talus, tibia, and fibula. The talus acts as a hinge within this complex, allowing the foot to move up (dorsiflexion) and down (plantarflexion). There are two ligamentous complexes that help provide stability to the ankle. The lateral ligamentous complex is made up of three ligaments: (1) anterior talofibular ligament, (2) posterior talofibular ligament, and (3) calcaneofibular ligament. The medial ligamentous complex is also known as the deltoid ligament and is composed of four ligaments: (1) anterior tibiotalar ligament, (2) posterior tibiotalar ligament, (3) tibiocalcaneal ligament, and (4) tibionavicular ligament. Because of these four ligaments, the medial ligamentous complex is more stable than the lateral complex, which is why most ankle sprains are due to an inversion injury. Of all the ligaments, the most common injured ligament is the anterior talofibular ligament (Figure 1).

Clinical Evaluation

History

A thorough history will help determine the severity of the ankle sprain as well as aid in determining if it is an injury other than an ankle sprain.

It is important to ask about the position of the ankle at the time of injury, the mechanism of the injury, and the time of the injury. This will help provide the location of the injury site and its associated pathology. A history of past or recurrent ankle sprains provides clues to the overall stability of the ligaments of the ankle and its predisposition to increased frequency of injury. Ascertaining whether the patient was immediately able to bear weight after the injury can provide information as to whether or not a fracture has occurred and the need for radiological evaluation. If the patient is a child, a growth plate fracture is likely, and radiographs of both ankles should be taken for comparison if indicated. A history of numbness in the foot could indicate a neurovascular injury, and proper medical attention should be given.

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