Making Synapses · Bringing Knowledge to Mankind
SportsAnkle sprain: history and mechanism of injury
An athlete comes off the field after rolling an ankle. Before touching it, you ask about the injury: how it happened and whether the ankle was hurt before. The mechanism points to the structures that may be damaged, and a previous sprain is the most common predisposing factor for a new one.
Free to startScenarios
- Lateral ankle sprain: the rearfoot rolled in (plantar flexion and inversion), often with the foot turned in.
- Medial ankle sprain: the foot turned out with the lower leg turned in.
- Forced extreme plantar flexion, as when tackled from behind, or extreme dorsiflexion, as when stepping in a hole.
The steps
- Ask about any history of injury to the ankle: a previous sprain is the most common predisposing factor for a recurrent sprain.
- Ask how the injury happened: the mechanism points to the structures that may be damaged.
- Recognize the most common lateral mechanism: the rearfoot rolls in while the lower leg turns out, often with the foot turned in as well.
- Think first of the anterior talofibular ligament, the most commonly sprained lateral ligament, then of the calcaneofibular ligament.
- If the foot turned out with the lower leg turned in, think of the deltoid ligament (medial sprain) and of the distal tibiofibular syndesmosis.
- If the ankle was forced into extreme plantar flexion or dorsiflexion, think of the syndesmosis.
- Ask whether the athlete could bear weight or keep playing before reporting the injury: it helps rule out a fracture.
Safety rules that stop the station
- The history points to the injured structures, but it may not show how severe the injury is.
To pass
- Previous injuries and the mechanism asked before the examination.
- The structures that may be injured named from the mechanism.
- Weight bearing and play after the injury asked.
Official source
Athletic trainers · NATA position statement
National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes (J Athl Train, 2013)
The National Athletic Trainers' Association position statement on ankle sprains (Journal of Athletic Training, 2013), free on PubMed Central: recommendation 1 and its literature review.
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