ANKLE

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)

TALAR TILT STRESS

ANTERIOR DRAWER STRESS

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