Ankle Sprain: (Twisted Ankle)

Presentation

Most patients with ankle sprains describe an inversion injury; eversion injuries are less common. Inversion injuries constitute 85% of ankle sprains. Patients may report having stepped off a curb or into a hole. Sports-related injuries often occur after jumping and landing on another player’s foot, which causes an inversion or supination of the ankle. There may be a sensation of a “pop” or “snap” at the time of injury with immediate loss of function suggesting disruption of a ligament. Severe swelling in the first hour suggests bleeding from the torn ligament ends. The body will rapidly respond with an inflammatory response, producing swelling, warmth, pain, and stiffness that build during the first few days postinjury.

Patients may present immediately after the injury or in the days following the injury complaining of pain, swelling, and partial or complete inability to walk. Patients are usually tender around the lateral malleolus, particularly anteriorly, because the anterior talofibular ligament is the first to tear when the ankle is inverted. Although the pain during the first hours after injury is often localized to the injured area, it becomes diffuse during the first few days. Once the initial inflammatory response has dissipated, careful palpation will confirm which ligaments were most likely injured.