Definition

Many ligaments assure the stability  of the ankle.

frequently due to Inversion type ankle injury on a plantarflexed foot.

The ATFL and CFL are frequently torn

Symptoms

• pain with weight bearing

• ecchymosis and swelling

• recurrent instability

Physical exam

• focal tenderness and swelling over-involved ligament(s): ATFL best tested in plantarflexion, CFL in dorsiflexion

• anterior drawer test: looks for excessive anterior displacement of talus relative to tibia

• Talar tilt test: excessive ankle inversion compared to contralateral side indicated injury to ATFL and CFL

Imaging

• Xrays :AP+ Lateral + Foot . usefull to rule out fracture or associated lesions.

• Varus stress views or auto-varus

• Extenal rotation stress View to eliminate syndesmosis injury

• MRI

  • consider MRI if pain persists for 6-8 weeks following sprain

  • useful to evaluate

    • peroneal tendon pathology

    • osteochondral injury

    • syndesmotic injury 

Associated injuries/conditions 

• osteochondral defects

• peroneal tendon injuries

• subtle cavovarus foot 

• deltoid ligament injury (isolated deltoid ligament injuries are very rare) 

  • superficial deltoid: limits talar abduction

  • deep deltoid: limits external rotation

• complex regional pain syndrome 

• retracted achilles tendon

• fractures

  • 5th metatarsal base

  • anterior process of calcaneus

  • lateral or posterior process of the talus

Treatment

Non operative Treatment : ALWAYS FIRST LINE (EVEN FOR SEVERE STRAIN)

• RICE (

• Elastic wrap to minimize swelling or ankle rigid orthosis (Aircast)

• Followed by Physical therapy

Surgical Treatment

• Only after failure of conservative treatment

• Many techniques exists

• a short leg cast will be necessary for 3 to 6 weeks

PAY ATTENTION NOT TO MISS A HIGH ANKLE SPRAIN !!!!1

• syndesmosis injury

  • anterior-inferior tibiofibular ligaments (AITFL)

  • posterior-inferior tibiofibular ligament (PITFL)

  • interosseous membrane (IOM)

  • interosseous ligament (IOL)

• Pain is usually higher than the classic ankle sprain. it is exacerbated by external rotation and squeeze test (midcalf level)

• Xrays should be obtained in external rotation. Findings

  • decreased tibiofibular overlap : normal >6 mm on AP view and >1 mm on mortise view

  • increased medial clear space : normal less than or equal to 4 mm

  • increased tibiofibular clear space : normal <6 mm on both AP and mortise views

  • Always obtain an xray of the full leg: maisonneuve fracture

Treatment

Nonoperative: if no diastasis or ankle instability

• non-weight-bearing CAM boot or cast for 2 to 3 weeks

Surgical

• screw fixation (need to be removed)

• suture button (quicker recovery ?)

• indications

  • syndesmotic sprain (without fracture) with instability on stress radiographs

  • syndesmotic sprain refractory to conservative treatment

  • syndesmotic injury with associated fracture that remains unstable after fixation of fracture

This information is a brief, simple medical explanation. For exhaustive details, and before starting any kind of treatment, please refer to Dr.BAYOUD