Harvey's Garden

Ankle sprains

1 min read

  • Types & Anatomy
    • Lateral Sprains (~85%):
      • Mechanism: Inversion + Plantarflexion.
      • Ligaments involved (in order of injury):
        1. Anterior Talofibular Ligament (ATFL): Most common; weakest.
        2. Calcaneofibular Ligament (CFL): Involved in more severe injuries. t
        3. Posterior Talofibular Ligament (PTFL): Rarely injured; only in severe dislocation.
    • Medial Sprains:
      • Mechanism: Eversion (forced external rotation).
      • Ligament: Deltoid ligament.
      • Rare due to strength of the ligament; often accompanied by avulsion fracture of the medial malleolus.
    • Syndesmotic Sprain (“High Ankle Sprain”):
      • Mechanism: Dorsiflexion + External rotation.
      • Injury to the Anterior Inferior Tibiofibular Ligament (AITFL).
  • Diagnostics: Ottawa Ankle Rules
    • X-Ray Indicated ONLY if:
      1. Tenderness at posterior edge/tip of Lateral or Medial Malleolus.
      2. Tenderness at Base of 5th Metatarsal or Navicular.
      3. Inability to bear weight (4 steps immediately & in ED).
  • Physical Exam
    • Anterior Drawer: Tests ATFL.
    • Talar Tilt: Tests CFL.
    • Squeeze Test: Tests Syndesmosis.
  • Treatment
    • RICE (Rest, Ice, Compression, Elevation), NSAIDs.
    • Early mobilization (weight-bearing as tolerated) > immobilization.
  • High-Yield Associations
    • Maisonneuve Fx: Proximal fibula fx associated with medial ankle injury. Always palpate proximal fibula.
    • Jones Fx: Fracture at base of 5th metatarsal (risk of nonunion due to watershed blood supply).

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