Management of Ankle Sprains
Top Contributors - Ewa Jaraczewska, Wanda van Niekerk, Jess Bell, Kim Jackson, Nupur Smit Shah and Tarina van der Stockt
Introduction[edit | edit source]
- Ankle sprains are one of the most common musculoskeletal injuries, being the most frequent musculoskeletal trauma among athletes.
- Most of these injuries are successfully treated conservatively; however, up to 70% of patients can develop long-lasting symptoms. Therefore, understanding prognostic factors for an ankle sprain could help clinicians identify patients with poor prognosis and choose the right treatment.
- A suggested approach will be presented in order to positively identify the factors that should warrant a more aggressive attitude in the initial conservative treatment.
- There are some prognostic factors linked to a better recovery and outcome; nevertheless, prognostic factors for full recovery after initial ankle sprain are not consistent.
Clinically Relevant Anatomy[edit | edit source]
Of the lateral ankle ligament complex the most frequently damaged one is the anterior talofibular ligament (ATFL). 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.
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"[1]
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 lateral ankle sprains and they are divided into two categories:intrinsic and extrinsic.
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.[2]
Reports have proposed that the greater the level of plantar flexion the higher the likelihood of sprain[3]
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.[4][5]
A less common mechanism of injury involves forceful eversion movement at the ankle injuring the strong deltoid ligament.
Classification Grading Systems[edit | edit source]
Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions[edit | edit source]
Acute Phase[edit | edit source]
Subacute Phase[edit | edit source]
Chronic Phase[edit | edit source]
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Resources
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References[edit | edit source]
- ↑ Beynnon BD, Murphy DF, Alosa DM. Predictive Factors for Lateral Ankle Sprains: A Literature Review. J Athl Train. 2002 Dec;37(4):376-380.
- ↑ Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008 Sep-Oct;43(5):523-9.
- ↑ 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.
- ↑ Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. 1994 Jun;28(2):112-6.
- ↑ 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.
