Ankle Sprains, Inversion & Eversion

KEY FEATURES

Essentials of Diagnosis

Inversion

• Most ankle injuries involve plantar flexion and inversion sprains affecting the lateral ligaments

• The anterior drawer test and talar tilt test are the best tests to grade ligament injury severity

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

Eversion (“High”)

• Severe and prolonged pain

• Limited range of motion

• Mild swelling

• Difficulty with weight bearing

General Considerations

Inversion

• Ankle sprains (stretch or tear of ankle ligaments) 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 a plantar flexion and inversion sprain, which injures the anterior talofibular ligament followed by 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 “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 43–9 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)

• 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 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 ...