Van der Bekerom et al 2012 completed a literature review on ankle sprains and brought forth some important information. It is estimated that ankle sprain make up 7-10% of all ER visits. Inversion sprains (twisting the ankle inwards) involves about 25% of musculoskeletal injuries. These account for 53% of basketball and 29% of soccer injuries. Clearly, ankle injuries are serious enough that some time considering their management should be taken.

Many physicians are still using the standard term “ankle sprain” without further classification. Hamilton and Kaikkonen 1982 developed a system of grade I, II and III. Grade I is a simple sprain where a rice protocol should provide sufficient rehabilitation. Grade II and III demonstrate real instability and require sometime in rehabilitation. This type of exam generally requires a physical exam which few ER doctors seems to do.

Studies have demonstrated that waiting 4-5 days after the trauma seems to give a more accurate physical exam (but if you choose to wait, be sure to accurately record your mechanism of injury and full history since 5 days later you will forget details) than an exam within the first 24-48 hours. Pain on palpation of a ligament with localized haematoma is 90% indication of a rupture. Another possible exam would be the anterior drawer test which is 73% sensitive and 97% specific. If both tests are positive, 98% chance of an injury to the ATF ligament. 40% of patients also having tearing of the capsule present when they tear their ligament.

Imaging such as MRI and Ultrasound can be used to determine the nature of the injury. Both are generally accurate and readily available in major ERs however their use is at the MDs discretion who may choose that more pressing cases like motor vehicle accident survivors need the machine more than you.

Depending on the degree of damage, physiotherapy can last from 4 weeks to 6 months with total remodeling time being as long as 1 year.

As we’ve discussed previously here, there are times to x-ray an ankle for a suspected fracture. We’ve also discussed managing chronic instability here. Good luck in training.