5-Minute Clinical Consult
Sprain, Ankle
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Basics
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.
- Lateral ankle sprains are the most common, accounting for up to 89% of all ankle sprains (1):
- 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
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
- 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
- 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
- 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
- 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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Basics
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.
- Lateral ankle sprains are the most common, accounting for up to 89% of all ankle sprains (1):
- 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
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
- 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
- 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
- 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
- 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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Citation
Stephens, Mark B., et al., editors. "Sprain, Ankle." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116893/all/Sprain__Ankle.
Sprain, Ankle. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116893/all/Sprain__Ankle. Accessed January 21, 2020.
Sprain, Ankle. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116893/all/Sprain__Ankle
Sprain, Ankle [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2020 January 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116893/all/Sprain__Ankle.
* Article titles in AMA citation format should be in sentence-case
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ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116893/all/Sprain__Ankle
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
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