Ankle Sprains

The ankle is made up of three bones, the tibia, fibula, and talus The tibia makes up the weight bearing and medial (inside) portion of the ankle. The fibula is located on the lateral (outside) aspect of the ankle. The talus sits beneath the tibia and between the medial and lateral malleoli, which are extensions of the tibia and fibula respectively.

There are three main types of ankle sprains.

  1. Lateral ankle sprains typically involve the anterior talofibular ligament and/or the calcaneofibular ligament(s). These typically result from an inversion mechanism.

  2. Medial ankle sprains involve the deltoid ligament (labeled above as the medial collateral ligament). These typically result from an eversion mechanism.

  3. High ankle sprains typically involve the anterior tibiofibular ligament as well as other portions of the syndesmosis. These are caused by an external rotation mechanism.

Signs & Symptoms:

Typically patients who sustain an ankle sprain will complain of pain and swelling. Bruising may present as well. The location of the pain and swelling depends on the mechanism and type of ankle sprain.

Patients may have difficulty with cutting or twisting activities.

Diagnosis:

Physical exam is usually enough to diagnose an ankle sprain. X rays may be performed in order to rule out a fracture. In chronic cases, MRI may be beneficial to assess the integrity of the ligaments or to diagnose an associated cartilage injury of the talus.

Treatment:

The treatment of ankle sprains depends upon the age, health, and activity level of the patient, extend of the injury, and associated injuries.

For most patients, non-surgical treatment is recommended. Non-surgical treatment consists of icing, anti-inflammatory medications, activity modifications, physical therapy, and a gradual return to activities as tolerated. Heat should be avoided after an acute injury.

In patients with chronic lateral ankle instability, a lateral ligament repair or reconstruction may be performed.

In cases of chronic high ankle sprains or an athlete with an acute high ankle sprain. Syndesmotic repair with a suture button device may be performed. This gained widespread attention after Tua Tagovailoa underwent the procedure while playing football at the University of Alabama.