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Ankle Sprain

Ankle Sprain is a topic covered in the 5-Minute Emergency Consult.

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  • Injuries to ligamentous supports of the ankle
  • Ankle joint is a hinge joint composed of the tibia, fibula, and talus.
  • Injuries may range from stretching with microscopic damage (grade I) to partial disruption (grade II) to complete disruption (grade III).


  • Forced inversion or eversion of the ankle
  • Forceful collisions
  • 85–90% of ankle sprains involve lateral ligaments:
    • Anterior talofibular (ATFL)
    • Posterior talofibular (PTFL)
    • Calcaneofibular (CFL)
    • Usually the result of an inversion injury
    • The ATFL is the most commonly injured.
    • If the ankle is injured in a neutral position, the CFL is often injured.
    • The PTFL is rarely injured alone.
  • Injury to the deltoid ligament (connecting the medial malleolus to the talus and navicular bones) is usually the result of an eversion injury:
    • Often associated with avulsion at the medial malleolus or talar insertion
    • Rarely found as an isolated injury
    • Suspect associated lateral malleolus fracture or fracture of the proximal fibula (Maisonneuve fracture).
  • Syndesmosis sprains (injury to the tibiofibular ligaments or the interosseous ligament of the leg):
    • Occur most commonly in collision sports
    • Syndesmosis injuries (“high ankle sprains”) have a higher morbidity and potential for long-term complications.

Pediatric Considerations
  • Children <10 yr with traumatic ankle pain and no radiologic evidence of fracture most likely have a Salter–Harris I fracture.
  • The ligaments are actually stronger than the open epiphysis.

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Rosen, Peter, et al., editors. "Ankle Sprain." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307271/all/Ankle_Sprain.
Ankle Sprain. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307271/all/Ankle_Sprain. Accessed April 23, 2019.
Ankle Sprain. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307271/all/Ankle_Sprain
Ankle Sprain [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307271/all/Ankle_Sprain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ankle Sprain ID - 307271 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307271/all/Ankle_Sprain PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -