LATERAL ANKLE SPRAIN — AN UPDATE

2013 ◽  
Vol 16 (04) ◽  
pp. 1330003
Author(s):  
Shibli Nuhmani ◽  
Moazzam Hussain Khan
Keyword(s):  
Ankle Sprain ◽  
Bone Fractures ◽  
Sports Injury ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Major Loss ◽  
Sporting Activities

Ankle sprain injuries are the most common injury sustained during sporting activities. One-sixth of all sports injury loss time is from ankle sprains. Each year, an estimated 1 million people present to physicians with acute ankle injuries. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. The diagnosis of a sprain relies on the medical history including symptoms, as well as making a differential diagnosis mainly in distinguishing it from strains or bone fractures. Despite their prevalence in society, ankle sprains still remain a difficult diagnostic and therapeutic challenge in the athlete, as well as in society in general. The high incidence of ligamentous ankle injuries requires clearly defined acute care and a broad knowledge of new methods in rehabilitation. In addition to rapid pain relief, the main objective of treatment is to quickly restore the range of motion of the ankle without any major loss of proprioception, thereby restoring full activity as soon as possible. The purpose of this article is to review the anatomy, pathomechanics, investigation, diagnosis and management of lateral ankle sprains.

Determination of In Situ Ankle Ligament Strains in Cases of High and Medial Ankle Sprains

2012 ◽  
Author(s):  
Keith D. Button ◽  
Feng Wei ◽  
Eric G. Meyer ◽  
Kathleen Fitzsimons ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
Ankle Injury ◽  
Ankle Injuries ◽  
Deltoid Ligament ◽  
Generic Model ◽  
Ankle Sprains ◽  
Ligament Injuries ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Tibiofibular Ligament

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries [1]. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. In order to help limit or mitigate ankle injuries, it is important to understand the mechanisms of injury. While numerous biomechanical studies have been conducted to investigate ankle injuries, most of them are designed to study ankle fractures rather than sprains. Ankle sprains have been graded in the clinical literature and associated with the degree of damage to a ligament resulting from excessive strains [2]. Recently, there have been studies of lateral ankle sprain in laboratory settings [3,4] and based on investigation of game films [5], providing considerable insight into the mechanism of lateral ankle sprain. On the other hand, few biomechanical studies have been conducted on high and medial ankle sprains. A more recent study from our laboratory used human cadaver limbs to investigate such injuries [6]. The study showed that the type of ankle injury, whether medial or high, under excessive levels of external foot rotation depends on the extent of foot eversion [6]. Everted limbs showed isolated anterior tibiofibular ligament injuries (high ankle sprain) only, while neutral limbs mostly demonstrated deltoid ligament failures (medial ankle sprain). Additionally, the study documented grade II (partial tears) and grade III (ruptures) ligament injuries. While a computational ankle model has also been developed and validated to help understand the mechanisms of injury [7], it is a generic model. The objective of the current study was to develop computational, subject-specific models from those cadaver limbs and determine the levels of ligament strain generated in the medial and high ankle injury cases, as well as correlate the grades of injury with ligament strains from the computational model.

Talofibular Interval Changes After Acute Ankle Sprain: A Stress Ultrasonography Study of Ankle Laxity

2013 ◽  
Vol 22 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Theodore Croy ◽  
Susan Saliba ◽  
Ethan Saliba ◽  
Mark W. Anderson ◽  
Jay Hertel
Keyword(s):  
Ankle Sprain ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Talocrural Joint ◽  
Lateral Ankle ◽  
Female Age ◽  
Anterior Drawer ◽  
Main Effect ◽  
Ability Measure ◽  
And Inversion

Introduction:Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.Methods:Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).Results:The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).Conclusions:Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.

Effect of Shoe Stiffness on Injury Produced Under External Rotation of the Foot in Human Cadavers

2013 ◽  
Author(s):  
Keith D. Button ◽  
Mark A. Davison ◽  
Jerrod E. Braman ◽  
Maureen C. Schaefer ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
External Rotation ◽  
Ankle Injuries ◽  
Upper Body ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
Interosseous Ligament ◽  
Lateral Ankle ◽  
Human Cadavers ◽  
Anterior Deltoid

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries 9. Injury to the lateral ligamentous complex occurs under excessive foot inversion and is known as a “lateral ankle sprain” 1. Injury to the anterior deltoid ligament (ADL), which consists of the tibionavicular ligament (TiNL) and the anterior tibiotalar ligament (ATiTL), is known as a “medial ankle sprain” 13. High ankle sprains occur in the distal tibiofibular syndesmosis, which is comprised of the anterior and posterior tibiofibular ligaments (ATiFL and PTiFL) and the interosseous ligament (IOL) 2. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. The mechanism of both high and medial ankle sprain is commonly ascribed to excessive internal rotation of the upper body, while the foot is planted on the playing surface.

scholarly journals The Role of the Calcaneofibular Ligament in Chronic Ankle Pain Following Severe Ankle Sprains

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Richard Alvarez ◽  
Randall Marx ◽  
Mark Mizel ◽  
Loren Latta ◽  
Paul Clifford
Keyword(s):  
Ankle Sprain ◽  
Plantar Flexion ◽  
Neutral Position ◽  
Peroneal Tendon ◽  
Ankle Sprains ◽  
Ankle Pain ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneal Tendons

Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was then dissected to observe the integrity and relationship of the lateral ankle structures. Results: Four of the eight specimens sustained CFL tears as viewed by MRI and confirmed through anatomic dissection. One of the four specimens with a CFL tear had a mid substance ligament rupture with the proximal half of the ligament positioned superficial to the peroneal tendon complex. This relationship was observed using the MRI. Conclusion: Creating severe lateral ankle sprain produced ruptures of the CFL with interposition of the peroneal tendon complex between the torn ends of the ligament was seen and identified. This phenomenon may prevent primary ligament healing of the CFL and may be a contributing factor in the chronic ankle pain of non-surgically treated lateral ankle sprains. Perhaps surgical intervention should be considered if clinical suspicion exists, such as with a Stener lesion of the hand.

scholarly journals Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masato Takao ◽  
Danielle Lowe ◽  
Satoru Ozeki ◽  
Xavier M. Oliva ◽  
Ryota Inokuchi ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Three Dimensional ◽  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Axial Motion ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Relative Strain ◽  
Maximal Strain

Abstract Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.

scholarly journals Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

Sports ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 41
Author(s):  
Philippe Terrier ◽  
Sébastien Piotton ◽  
Ilona M. Punt ◽  
Jean-Luc Ziltener ◽  
Lara Allet
Keyword(s):  
Ankle Sprain ◽  
Strength Function ◽  
Selection Procedure ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Functional Scores ◽  
Logistic Regressions ◽  
Poor Outcomes ◽  
Clinical Measures

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

scholarly journals Role of magnetic resonance imaging in ankle sprains

2021 ◽  
Vol 25 (1) ◽  
pp. 438-445
Author(s):  
Nawroz Othman ◽  
Salwa AL-Najjar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Evaluation ◽  
Ankle Sprain ◽  
Soft Tissues ◽  
Ankle Injuries ◽  
Bone Lesions ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Imaging Results

Background and objective: Musculoskeletal injuries frequently occur in the ankle in both the athletic and general population. Ankle sprains are among the most frequent types of ankle injuries, which are conventionally diagnosed through clinical examinations. However, magnetic resonance imaging can provide a more precise diagnosis, leading to better injury management and prevention of consequent chronic complications. The present study aimed to examine the significance of magnetic resonance imaging in detecting and assessing changes that occur in ligaments and soft tissues in patients with ankle sprains. Methods: In a prospective study, 50 patients with ankle sprain referred to Rizgary and Erbil Teaching hospitals in Erbil city, Iraqi Kurdistan Region, from March 2018 to April 2019, were included in the study. They underwent clinical evaluation and MRI (GE general electric 1.5 Tesla). Two expert radiologists analyzed the magnetic resonance imaging images, and the results were compared. The collected data were analyzed using SPSS version 23 through descriptive statistics. Results: Most patients (64%) belonged to the age groups of 30-49 years old. Most of them (64%) were males. Most events of ankle sprain (66%) were because of sports and accidents. The clinical evaluation proved 82% of the ankle sprains. Regarding the laterality of the lesions, 60% were spotted in the right ankles and 40% in the left. According to magnetic resonance imaging results, both radiologists diagnosed that the ankle sprains included bone lesions, ligament injury, tendon injury, and effusion. There was an agreement of ≥ 96% between the two radiologists in this regard. The two radiologists were not significantly different in terms of diagnosing the ligament side. As reported by the radiologists based on the magnetic resonance imaging images, the anterior, lateral, and medial tendons were normal in most cases. Conclusion: Magnetic resonance imaging is a vitally important tool that can be utilized reliably and accurately to diagnose and evaluate changes in ligaments and soft tissues in patients with ankle sprains. Keywords: Magnetic resonance imaging (MRI); Ankle sprain; Ligaments; Injuries.

Evaluation of the Sports Ankle Rating System in Young, Athletic Individuals with Acute Lateral Ankle Sprains

2003 ◽  
Vol 24 (3) ◽  
pp. 274-282 ◽  
Author(s):  
Glenn N. Williams ◽  
Joseph M. Molloy ◽  
Thomas M. DeBerardino ◽  
Robert A. Arciero ◽  
Dean C. Taylor
Keyword(s):  
Ankle Injuries ◽  
Rating System ◽  
Ankle Sprains ◽  
Rating Score ◽  
Lateral Ankle ◽  
Life Measure ◽  
Initial Validation ◽  
Unique System ◽  
The Impact

The purpose of this paper is to introduce the Sports Ankle Rating System and provide the initial validation for its use. As its name implies, this outcomes measurement system is intended for use in assessing the functional outcomes of athletes with ankle injuries. This unique system consists of three distinct instruments: the Quality of Life Measure, the Clinical Rating Score, and the Single Assessment Numeric Evaluation. We began the validation process of the Sports Ankle Rating System with subjects who had sustained lateral ankle sprains because this is the most common injury in sports. The results of this study indicate that the Sports Ankle Rating System is: effective at assessing the impact that an ankle sprain has on an athlete's functional and psychosocial status responsive to changes in an athlete's ankle-related health status, and valid and reliable as tested.

The Snowboarder's Foot and Ankle

1998 ◽  
Vol 26 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Douglas P. Kirkpatrick ◽  
Robert E. Hunter ◽  
Peter C. Janes ◽  
Jackie Mastrangelo ◽  
Richard A. Nicholas
Keyword(s):  
Injury Rate ◽  
Soft Tissue Injuries ◽  
Fracture Pattern ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Foot And Ankle ◽  
Foot Injuries ◽  
Lateral Process ◽  
Ski Resorts

We undertook a prospective study to determine the type and distribution of foot and ankle snowboarding injuries. Reports of 3213 snowboarding injuries were collected from 12 Colorado ski resorts between 1988 and 1995. Of these, 491 (15.3%) were ankle injuries and 58 (1.8%) were foot injuries. Ankle injuries included 216 (44%) fractures and 255 (52%) sprains. Thirty-three (57%) of the foot injuries were fractures and 16 (28%) were sprains. The remaining injuries were soft tissue injuries, contusions, or abrasions. There was no significant correlation between boot type (soft, hybrid, or hard) and overall foot or ankle injury rate. There were significantly fewer ankle sprains in patients wearing hybrid boots and fewer fractures of the lateral process of the talus in patients wearing soft boots. An unexpectedly high number of fractures of the lateral process of the talus were noted. These 74 fractures represented 2.3% of all snowboarding injuries, 15% of all ankle injuries, and 34% of the ankle fractures. Many of these fractures are not visible on plain radiographs and require computed tomography imaging to be diagnosed. Diagnosis of this fracture pattern is paramount; the physician should be very suspicious of anterolateral ankle pain in the snowboarder, where subtle fractures that may require surgical intervention can be confused with anterior talofibular ligament sprains.

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