Ankle Sprains, Inversion & Eversion

Key Features

Essentials of Diagnosis

Inversion

• 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

Eversion

• Severe and prolonged pain

• Limited range of motion

• Mild swelling

• Difficulty with weight bearing

General Considerations

Inversion

• 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

• Chronic ankle instability

  • Defined as persistent complaints of pain, swelling and/or giving way in combination with recurrent sprains for at least 12 months after the initial ankle sprain

  • Can occur in up to 43% of ankle sprains even with physical therapy, which makes appropriate attention to acute ankle sprains important

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

Eversion

• 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

Inversion

• 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

Eversion

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

• The point of maximal tenderness involves the ...