Sprain, Ankle
Basics
Basics
Basics
Description
Description
Description
The most common cause of ankle injury comprising a significant proportion of sports injuries:
- Types of ankle sprains: lateral, medial, and syndesmotic (or high ankle sprain)
- Lateral ankle sprains are the most common, accounting for up to 89% of all ankle sprains (1):
- In lateral ankle sprains, the anterior talofibular ligament (ATFL) is most likely to be injured.
- The calcaneofibular ligament (CFL) is the second most likely ligament to be injured.
- The posterior talofibular ligament (PTFL) is the least likely to be injured.
- Medial ankle sprains (5–10%) result from an injury to the deltoid ligament.
- Syndesmotic (“high ankle sprain”) injuries account for 5–10% of ankle sprains.
- The syndesmosis between the distal tibia and distal fibula bones consists of the anterior, posterior, and transverse tibiofibular ligaments; the interosseous ligament; and interosseous membrane.
- Ankle sprains are classified according to the degree of ligamentous disruption:
- Grade I: mild stretching of a ligament with possible microscopic tears
- Grade II: incomplete tear of a ligament
- Grade III: complete ligament tear
Geriatric Considerations
Increased risk of fracture in patients with preexisting bone weakness (osteoporosis/osteopenia)
Pediatric Considerations
- Increased risk of physeal injuries instead of ligament sprain because ligaments have greater tensile strength than physes
- Inversion ankle injuries in children may have a concomitant fibular physeal injury (Salter-Harris type I or higher fracture).
- Consider tarsal coalition with recurrent ankle sprains.
Epidemiology
Epidemiology
Epidemiology
Incidence
- Ankle sprains are more common in childhood and adolescents, particularly in active individuals (2).
- 1/2 of all ankle sprains are sports related; highest incidence in indoor/court sports (basketball, volleyball, tennis), followed by football and soccer (3)
- Most common sports injury
- More common in males age <30 years and females >30 years old
Prevalence
- 25% of sports injuries in the United States
- 75% of all ankle injuries are sprains.
Etiology and Pathophysiology
Etiology and Pathophysiology
Etiology and Pathophysiology
- Lateral ankle sprains result from an inversion force with the ankle in plantar flexion.
- Medial ankle sprains are due to forced eversion while the foot is in dorsiflexion.
- Syndesmotic sprains result from eversion stress/extreme dorsiflexion along with internal rotation of tibia.
Risk Factors
Risk Factors
Risk Factors
- The greatest risk factor is a prior history of an ankle sprain (3–34% recurrence rate).
- Postural instability, gait alterations
- Joint laxity and decreased proprioception are not risk factors.
General Prevention
General Prevention
General Prevention
- Improve overall physical conditioning:
- Training in agility and flexibility
- Single-leg balancing
- Proprioceptive training
- Taping and bracing may help prevent primary injury in selected sports (i.e., volleyball, basketball, football) or reinjury (4). Taping and bracing do not reduce sprain severity.
Weight loss may help in overweight patients (
4)[
A].
Commonly Associated Conditions
Commonly Associated Conditions
Commonly Associated Conditions
- Contusions
- Fractures
- Fibular head fracture/dislocation (Maisonneuve)
- Fracture of the base of the 5th metatarsal
- Distal fibula physeal fracture (includes Salter-Harris fractures in pediatric patients; most common type of pediatric ankle fracture)
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