Ankle Sprain

What is it?
​An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of actvities. It can happen in the setting of an ankle fracture (i.e. when the bones of the ankle also break). Most commonly, however, it occurs in isolation.
Symptoms and Clinical Presentation
​Patients present after having twisted their ankle. This usually occurs due to an inversion injury which means the foot rolls underneath the ankle or leg. It commonly occurs during sports. Patients will present with pain on the outside of their ankle. They can have various degrees of swelling and bleeding under the skin (i.e. bruising). Technically, this bruising is referred to as “ecchymosis.” Depending on the severity of the sprain, a person may or may not be able to put weight on the foot.
Cause (including risk factors)
​As noted above, these injuries occur when the ankle is twisted underneath the leg, called inversion. Risk factors are those activities, such as basketball and jumping sports, in which an athlete can come down and turn the ankle or step on an opponents’ foot. There are other predispositions as well. In people with a hindfoot “varus,” which means that the general nature or posture of the heels is slightly turned towards the inside, these injuries are more common. This is because it is easier to turn on the ankle. In those who have had a severe sprain in the past, it is also more easy to turn the ankle and cause a sprain. Therefore, one of the risk factors of spraining the ankle is having instability. Those who have weak muscles, especially those called the peroneals which run along the outside of the ankle, may be more predisposed. The job of the peroneal muscles is to “evert” the ankle (i.e. the opposite of invert which is what happens during a sprain).
​There are multiple ligaments in the ankle. Ligaments in general are those structures that connect bone-to-bone. Tendons on the other hand connect muscle-to-bone and allow those muscles to exert their force. In the case of an ankle sprain, there are several commonly sprained (i.e. torn) ligaments. The two most important are the following (Figures 1 and 2):
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