Ankle Sprain

Question 1

Epidemiology of ankle sprain

Answer 1

• most common ankle joint injury
• Lateral ligament sprain most common of ankle sprains
• Indoor sports e.g. basketball carry greatest risk

Question 2

What causes an ankle sprain? (Aetiology)

Answer 2

• Fall that causes ankle to twist
• Exercising on uneven surfaces
• Previous history of sprain
• Another person stepping or landing on foot
• Can occur from rapid shift of body mass over the wight bearing foot

Question 3

Which ligament is most commonly injured in ankle sprain and how?

Answer 3

Anterior Talofibular Ligament (ATFL)
When plantar flexed foot is forcefully inverted

Question 4

Which ligaments are least likely to get injured (ankle sprain)

Answer 4

Calcaneofibular (CFL) and Posterior Talofibular (PTFL)

Question 5

How do medial sprains occur?

Answer 5

By forceful pronation and rotation movements of the hind foot

Question 6

What are the signs of a sprained ankle?

Answer 6

• Pain (especially when bearing weight)
• Tenderness
  -Bruising and swelling
• Limited ROM
• Instability

Question 7

Which special tests can be conducted for an ankle sprain?

Answer 7

Anterior drawer test, Talar tilt and Squeeze test

Question 8

How is the Anterior drawer test conducted?

Answer 8

• Patient placed in prone position with ankle extending beyond bed
• Talofibular joint stabilised
• Heel held and anterior force applied
• Positive result: excessive anterior movement of foot and dimpling of skin besides achilles tendon

Question 9

How is the talar tilt conducted?

Answer 9

• Patient seated
• Foot positioned in 10-20º plantarflexion
• Distal leg stabilised and hind foot inverted
• Positive result: significant inversion as compared to other foot

Question 10

How is the squeeze test conducted?

Answer 10

• Compression of proximal fibula against the tibia
• Positive result: pain occurs indicating fracture or diastasis

Question 11

Classification system of ankle sprain with imaging

Answer 11

Grade 1- slight stretching and damage to ligament
Grade 2- partial tear of ligament
Grade 3- complete rupture of ligament

Question 12

Classification system of ankle sprain without imaging

Answer 12

Grade 1- mild impairment with minimal swelling and little impact on function
Grade 2- moderate impairment with moderate pain, swelling and tenderness. Decreased ROM and stability
Grade 3- severe impairment with significant swelling , loss of function and instability

Question 13

How should a potential ankle sprain be assessed?

Answer 13

• take medical history
• observe gait, deformity, mal-alignment and swelling
• take note of tenderness
• assess passive and active ROM

Question 14

What is the goal of treatment for an ankle sprain?

Answer 14

• decrease pain and swelling
• protect ligament from further injury
• restore function and stability

Question 15

What is the common treatment protocol for an ankle sprain?

Answer 15

• PRICE
• Protection through crutches or brace or tape

Question 16

What are the three stages of recovery? (ankle sprain)

Answer 16

• Inflammatory phase
• Proliferative phase
• Remodelling phase

Question 17

What does the inflammatory phase of a sprain involve?

Answer 17

• reduce pain and swelling through PRICE and NSAIDs
• Provide support for joint

Question 18

What does the proliferative phase of a sprain involve?

Answer 18

• occurs after swelling reduced
• improve weight bearing
• Increase ROM
• prevent further injury
• brace/tape can be used at the beginning of this phase to reduce further injury

Question 19

What does the remodelling phase of a sprain involve?

Answer 19

• long-term process
• improve muscle strength, active stability, motion and mobility
• use of static and dynamic exercises

Question 20

Which tests should be carried out to determine if you can return to normal activities? (ankle sprain)

Answer 20

• knee to wall test
• lower limb strength
• static balance test
• dynamic balance test
• agility test