Acute Ankle Sprains
Clinical Presentation
A careful history and physical examination is crucial when
evaluating a patient with an acute ankle sprain, as it can elicit
the severity of the injury. A patient usually describes “rolling
over” his or her ankle due to a combination of inversion,
plantar flexion, or internal rotation of the ankle. The patient
will likely report acute lateral ankle pain and, the physician
may elicit the extent of ligament injury by inquiring about
swelling, ability to bear weight and subsequent ecchymosis.
On physical examination, patients can localize the lateral
ankle tenderness in the acute setting but the pain and swell
-
ing becomes more diffuse over the next few days. Careful
palpation can confirm the structures involved in the injury—
localized ATFL tenderness is exhibited at 4 to 7 days post
injury, while CFL injury can be diagnosed with tenderness
at the calcaneal insertion. Funder and coworkers
18
found
that 52% of patients with ATFL tenderness indeed had a
ruptured ATFL, while 72% of patients with CFL insertional
tenderness had a ruptured CFL