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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