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Key Features

Essentials of Diagnosis


  • Localized pain and swelling

  • Most ankle injuries involve inversion injuries affecting the lateral ligaments

  • Consider chronic ankle instability or associated injuries if pain persists for > 3 months following an ankle sprain


  • Severe and prolonged pain

  • Limited range of motion

  • Mild swelling

  • Difficulty with weight bearing

General Considerations


  • Ankle sprains are the most common sports injuries seen in outpatient clinics

  • Patients usually report "turning the ankle" during a fall or after landing on an irregular surface

  • The most common mechanism of injury is an inversion and plantarflexion sprain, which injures the anterior talofibular ligament rather than the calcaneofibular ligament

  • Women appear to sustain an inversion injury more frequently than men

  • See Table 41–8 for other injuries that can occur with inversion ankle injuries

Table 41–8.Injuries associated with ankle sprains.

  • A syndesmotic injury or "high ankle" sprain involves the anterior tibiofibular ligament in the anterolateral aspect of the ankle, superior to the anterior talofibular ligament

  • The injury mechanism often involves the foot being turned out or externally rotated and everted (eg, when being tackled)

  • This injury is commonly missed or misdiagnosed as an anterior talofibular ligament sprain on initial visit

Clinical Findings

Symptoms and Signs


  • Localized pain, swelling, and bruising over the lateral aspect of the ankle

  • Difficulty weight bearing

  • Limping

  • The patient's ankle may feel unstable

  • The anterior, inferior aspect below the lateral malleolus is most often the point of maximal tenderness consistent with anterior talofibular and calcaneofibular ligament injuries


  • Severe and prolonged pain over the anterior ankle at the anterior tibiofibular ligament, worse with weight bearing

  • The point of maximal tenderness involves the anterior tibiofibular ligament, which is higher than the anterior talofibular ligament

  • It is also important to palpate the proximal fibula to rule out any proximal syndesmotic ligament injury and associated fracture known as a "maisonneuve fracture"

  • There is often some mild swelling in this area, and the patient may or may not have an ankle effusion

  • The patient usually has limited range of motion in all directions



  • Routine radiographic views include the anteroposterior, lateral, and oblique (mortise) views

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