SPRAIN
(ankle
instability)
Dr.
Muh,
Sak,
SpOT
A N A T O M Y
H
I
S
T
O
R
Y
Acute
injury
Pa,ent
may
report
inversion
and
plantarexion
mechanism
Popping
or
tearing
sensa,on
in
the
ankle
Some,mes
audible
pop
reported
(rare)
Swelling,
bruising
and
pain
on
the
lateral
(medial
less
common)
aspect
of
the
ankle
Chronic
injury
Recurrent
ankle
sprains
with
increasingly
less
severe
trauma
PHYSICAL
EXAMINATION
INSPECTION
:
Eusion
(intra-ar,cular
swelling)
Hindfoot
alignment
PALPATION
:
Keep
in
mind
that
in
the
acute
phase,
the
specicity
of
tenderness
is
reduced
(repeat
examina,on
35
days
aWer
ini,al
injury).
Anterolateral
(ATFL)
and
inferior
(CFL)
ankle
tenderness
Possible
tenderness
along
the
peroneal
tendons
Possible
tenderness
at
the
,p
of
the
bula
PHYSICAL
EXAMINATION
RANGE
OF
MOTION
:
Loss
of
dorsiexion/plantarexion/inversion
due
to
eusion
Analyze
poten,al
hypermobility
of
joints
SPECIAL
TEST
(not
possible
to
perform
in
the
acute
phase)
:
Anterior
drawer
test:
ATFL
Inversion
stress
test
:
CFL
External
rota,on
stress
test
:
syndesmosis
R
A
D
I
O
G
R
A
P
H
Y
Radiographs:
weight-bearing
anteroposterior,
mor,se,
and
lateral
views
of
the
ankle
Check
for
avulsion
fractures
and
osteochondral
lesions.
Stress
radiographs
Talar
,lt
stress:
Talar
,lt
greater
than
15
degrees
compared
with
the
contralateral
side
is
suspicious
for
complete
tear
of
the
CFL.
Anterior
drawer
stress:
Anterior
transla,on
of
the
talus
greater
than
5
mm
is
considered
a
tear
of
the
ATFL.
Magne,c
resonance
imaging
(MRI;
not
required
in
the
acute
phase
of
injury)
TREATMENT
At
diagnosis
(ACUTE)
Rest,
ice,
compression,
and
eleva,on
un,l
swelling
decreases
(usually
35
days)
Nonsteroidal
an,-inammatory
medica,on
reduces
pain.
AWer
swelling
has
subsided,
stability
of
the
joint
is
re-
evaluated,
and
a
short
ankle
soW
cast
(in
neutral
posi,on)
is
applied.
Rehabilita,on
is
started
with
propriocep,ve
training,
range-of-mo,on
exercises,
peroneal
and
ankle
dorsiexor
strengthening,
and
Achilles
tendon
stretching
T
R
E
A
T
M
E
N
T
LATER
(CHRONIC)
:
Repe,,ve
ankle
sprains,
even
on
at
surfaces,
indicate
the
presence
of
chronic
lateral
ankle
instability.
Repair
ligament
(Surgery)
Other
nonsurgical
treatment
op,ons
include
ac,vity
and
shoe
modica,on
(lower
heels,
s,er
soles,
lateral
heel
wedge),
an
ankle-foot
orthosis
with
ankle
(and
perhaps
subtalar)
support,
and
orthoses
with
a
lateral
heel
wedge