Management of Ankle Sprains: Difference between revisions

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== Introduction ==
== Introduction ==
Ankle sprains are considered one of the most frequent traumatic type of injury. Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one.<ref name=":0" /><ref name=":1" />A conservative treatment is the common approach to ankle injury. The prognosis is generally good, but there is a number of factors influencing the full recovery.<ref name=":2">Ferreira JN, Vide J, Mendes D, Protásio J, Viegas R, Sousa MR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336189/pdf/eor-5-334.pdf Prognostic factors in ankle sprains: a review.] EFORT Open Rev. 2020 Jun 1;5(6):334-338. </ref>These factors, when early identified, can change the treatment protocol to more aggressive approach.<ref name=":2" />  
Ankle sprains are considered one of the most frequent traumatic type of injuries. Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one.<ref name=":0">Yeung MS, Chan KM, So CH, Yuan WY. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332043/pdf/brjsmed00014-0042.pdf An epidemiological survey on ankle sprain.] Br J Sports Med. 1994 Jun;28(2):112-6. </ref>There were reports proposing that the greater the level of plantar flexion the higher the likelihood of sprain. <ref>Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech. 2000 May;33(5):513-9.</ref>A conservative treatment is the common approach to ankle injury. The prognosis is generally good, but there is a number of factors influencing the full recovery.<ref name=":2">Ferreira JN, Vide J, Mendes D, Protásio J, Viegas R, Sousa MR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336189/pdf/eor-5-334.pdf Prognostic factors in ankle sprains: a review.] EFORT Open Rev. 2020 Jun 1;5(6):334-338. </ref>These factors, when early identified, can change the treatment protocol to more aggressive approach.<ref name=":2" />  


== Clinically Relevant Anatomy ==
== Clinically Relevant Anatomy ==
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=== Predisposing Factors ===
=== Predisposing Factors ===
Predisposing factors are the risk factors for lateral ankle sprains and they are divided into two categories:intrinsic and extrinsic.<ref name=":2" />
Predisposing factors are the risk factors for the ankle sprains. <ref name=":2" /> Identifying risk factors helps the clinician to choose the most appropriate treatment regimen given the fact that those risk factors have a significant impact on the patient's recovery.<ref name=":2" />They are divided into two categories:intrinsic and extrinsic.


Intrinsic risk factors for outcome prediction include:


* age
* activity level
* grade of injury
* functional status
* associated injury






Lateral ankle sprains usually occur during a rapid shift of body center of mass over the landing or weight-bearing foot. The ankle rolls outward, whilst the foot turns inward causing the lateral ligament to stretch and tear. When a ligament tears or is overstretched its previous elasticity and resilience rarely returns. Some researchers have described situations where return to play is allowed too early, compromising sufficient ligamentous repair.<ref>Hubbard TJ, Hicks-Little CA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2547872/pdf/attr-43-05-523.pdf Ankle ligament healing after an acute ankle sprain: an evidence-based approach]. J Athl Train. 2008 Sep-Oct;43(5):523-9. </ref><br>Reports have proposed that the greater the level of plantar flexion the higher the likelihood of sprain<ref>Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech. 2000 May;33(5):513-9.</ref>
 
 
Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one.<ref name=":0">Yeung MS, Chan KM, So CH, Yuan WY. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332043/pdf/brjsmed00014-0042.pdf An epidemiological survey on ankle sprain.] Br J Sports Med. 1994 Jun;28(2):112-6. </ref><ref name=":1">Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports. Am J Sports Med. 2017 Jan;45(1):201-209.</ref>
 
A less common mechanism of injury involves forceful eversion movement at the ankle injuring the strong deltoid ligament.  


== Classification Grading Systems ==
== Classification Grading Systems ==

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Introduction[edit | edit source]

Ankle sprains are considered one of the most frequent traumatic type of injuries. Yeung et al, 1994, in an epidemiological study of unilateral ankle sprains, reported that the dominant leg is 2.4 times more vulnerable to sprain than the non-dominant one.[1]There were reports proposing that the greater the level of plantar flexion the higher the likelihood of sprain. [2]A conservative treatment is the common approach to ankle injury. The prognosis is generally good, but there is a number of factors influencing the full recovery.[3]These factors, when early identified, can change the treatment protocol to more aggressive approach.[3]

Clinically Relevant Anatomy[edit | edit source]

Lateral Ankle Sprain[edit | edit source]

The literature suggests that 85% of the ankle sprains involves lateral ligaments. [4]The anterior talofibular ligament (ATFL) of the lateral ankle ligament complex is the most frequently damaged when lateral ankle sprain occurs. Their anatomical location and the mechanism of sprain injury mean that the calcaneo-fibular (CFL) and posterior talofibular ligaments (PTFL) are less likely to sustain damaging loads.

Medial Ankle Sprain[edit | edit source]

On the medial side the strong, deltoid ligament complex [posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL) and anterior tibiotalar ligaments (ATTL)] is injured with forceful "pronation and rotation movements of the hindfoot". [5]

Syndesmotic Ankle Sprain[edit | edit source]


The stabilising ligaments of the distal tibio-fibular syndesmosis are the anterior-inferior, posterior-inferior, and transverse tibio-fibular ligaments, the interosseous membrane and ligament, and the inferior transverse ligament. A syndesmotic ankle sprain occurs with combined external rotation of the leg and dorsiflexion of the ankle.

Mechanism of Injury[edit | edit source]

Predisposing Factors[edit | edit source]

Predisposing factors are the risk factors for the ankle sprains. [3] Identifying risk factors helps the clinician to choose the most appropriate treatment regimen given the fact that those risk factors have a significant impact on the patient's recovery.[3]They are divided into two categories:intrinsic and extrinsic.

Intrinsic risk factors for outcome prediction include:

  • age
  • activity level
  • grade of injury
  • functional status
  • associated injury


 

Classification Grading Systems[edit | edit source]

Clinical Presentation[edit | edit source]

add text here relating to the clinical presentation of the condition

Diagnostic Procedures[edit | edit source]

add text here relating to diagnostic tests for the condition

Outcome Measures[edit | edit source]

add links to outcome measures here (see Outcome Measures Database)

Algorythm to acute ankle sprain

Management[edit | edit source]

Acute Phase[edit | edit source]

Subacute Phase[edit | edit source]

Chronic Phase[edit | edit source]

add text here relating to management approaches to the condition

Resources
[edit | edit source]

add appropriate resources here

References[edit | edit source]

  1. ↑ Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. 1994 Jun;28(2):112-6.
  2. ↑ Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech. 2000 May;33(5):513-9.
  3. ↑ 3.0 3.1 3.2 3.3 Ferreira JN, Vide J, Mendes D, Protásio J, Viegas R, Sousa MR. Prognostic factors in ankle sprains: a review. EFORT Open Rev. 2020 Jun 1;5(6):334-338.
  4. ↑ Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop. 2020 Dec 18;11(12):534-558.
  5. ↑ Beynnon BD, Murphy DF, Alosa DM. Predictive Factors for Lateral Ankle Sprains: A Literature Review. J Athl Train. 2002 Dec;37(4):376-380.
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