SOFT TISSUE MANAGEMENT DIAGNOSIS AND MANAGEMENT OF THE SPRAINED ANKLE
‘Sprains’ or ligamentous injuries of the ankle joint are commonly seen in general practice while 600,000 a year are presented to accident and emergency departments across the UK.
Although often regarded as trivial, ligamentous sprains result in persistent pain and instability in up to 30% of cases. An accurate diagnosis and structured rehabilitation programme will reduce the likelihood of long term complications.
The ankle joint, which is made up of the tibia and fibula forming a mortice joint around the talus, is supported by strong surrounding medial and lateral ligaments. Approximately 95% of sprains of the ankle joint affect the lateral ligament complex. An injury to the medial ligament is rare and usually accompanies a fracture to the lateral malleolus. Anatomically the lateral ligament consists of three components (Fig.1):
The ATFL runs almost horizontally and is intimately involved with the joint capsule. It is the first ligament to be strained. Further inversion damages the stronger CFL. The PTFL is not usually injured.
Patients usually have a history of the ankle ‘turning’ or ‘going over’ into inversion. Pain without the rapid onset of swelling and with the ability to continue with sport or other activity suggests a minor sprain. Severe pain at the time of injury with immediate localised swelling and inability to weight bear is likely to be the result of significant injury or fracture. Other pointers to a more severe injury include an audible ‘crack’, ‘snap’ or tearing sensation at the time of injury.
Examination Figure 1: Lateral view of the ankle joint 24 SportEX
The appearance of the ankle will depend on the delay in presentation following injury. Pain may increase over the first 24 hours as swelling reaches a maximum.