An ankle sprain is a stretch or tear of the ankle ligaments, most often the outer ligaments when the foot rolls inward. Most heal well with early movement and rehab, and the main task is to rule out a fracture.
Key symptoms
- Pain on the outside of the ankle after rolling the foot
- Swelling and bruising
- Pain when walking or putting weight on the foot
- A pop at the moment of injury in some cases
What you find on exam
- Tenderness over the outer ligaments, most often the anterior talofibular ligament
- Ottawa rules: bone tenderness at the back edge or tip of either malleolus, or unable to take 4 steps
- Anterior drawer and talar tilt tests for ligament laxity
- Pulses, sensation, the base of the fifth metatarsal and the navicular
Tests
- X-ray only if the Ottawa ankle rules are positive
- Stress views or MRI if pain and instability persist
- Squeeze test to look for a high ankle sprain
Treatment basics
- Rest, ice, compression and elevation in the first days
- NSAIDs such as ibuprofen or naproxen for pain
- Brace or lace-up support with early weight bearing as tolerated
- Balance and strength exercises to prevent repeat sprains
- Crutches for a short time if walking is too painful
Red flags
- Unable to bear weight or bone tenderness at the Ottawa points
- Numbness, a cold foot or weak pulses
- Deformity, or a high ankle sprain with a widened joint
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.