Lateral or inversion ankle sprains are the most common ankle injuries. This type of injury
is most often caused by “rolling the ankle” which is truly plantarflexion and inversion of the
ankle together putting the foot in extreme supination. The anatomy of the ankle and a sports
demand on the ankle are the main reason why this injury is so prevalent. The true ankle joint is
called the Talocrural Joint. The Talocrural joint is formed by the talus, tibia and fibula. Three
ligaments support the lateral side of that joint called the Anterior Talofibular, Calcaneofibular,
and Posterior Talofibular. The medial side is protected by a band of four ligaments called the
deltoid ligament. Since the deltoid ligament is so strong it helps prevent eversion ankle sprains.
Lateral sprains on the other hand are so common because most athletic skills require extreme
amounts of supination, which is needed for a lateral sprain to occur. (Starkey, Ryan) In the case
of a 2nd degree lateral ankle sprains both the Anterior Talofibular Ligament and the
Calcaneofibular Ligament are partially torn (Ivins). There are many signs and symptoms that can
give the examiner an idea of what type of injury they are dealing with. Pain, bruising or
ecchymosis, swelling and deformity can be present after an injury to the ankle (Lynam). There is
no prevalence of this injury aimed towards males or females, it happens to both evenly. Lateral
ankle sprains can be seen in athletes who play soccer, softball, football, skating, diving, field
hockey, competitive cheerleading, basketball and many others as well (Fong). Ankle sprains can
become chronic if the acute injury is not taken care of properly, so it is very easy for someone
who has had an ankle sprain before to be susceptible to them again; in other words an acute ankle
injury can become a chronic ankle injury.
Personal Data/History
This inversion ankle sprain occurred to an 18 year old male diver from Rowan University. The
athlete was about to perform his dive and as he went up on his toes he heard and felt a pop in his
right ankle. At this point he was unable to continue and went directly to the Athletic Training
room. The athlete at this point mentions that he has had a previous injury to the same ankle
during high school, in the 2005 diving season. He reported his pain to be 5 out of 10, with 10
being the most painful, and it was localized on the lateral side of his right ankle. There was little
swelling or discoloration that first day but as the days went on he complained of more pain, there
was more swelling, he developed a gait, and a large increase in eccymosis appeared. In some
cases, like this one, eccymosis can take a while to appear and often pools around the foot
(Lynam).
Assessment Results
The physical examination showed edema over the sinus tarsi, and mild discoloration, with no
deformity, or gait. All bony palpations were negative for pain, including the medial malleolus,
base of the 5th metatarsal, fibula and tibia. Soft tissue palpations were positive for pain over the
Anterior Talofibular Ligament (ATF), the Calcaneofibular Ligament (CF), and the syndesmosis
joint (tib-fib joint). There was no pain when the Posterior Talofibular Ligament (PTF), Achilles
tendon, or Peroneal Tubercle areas were palpated. Range of motion testing showed no deficits in
plantarflexion, dorseflexion, or eversion. Inversion was recorded as being full but painful.
Manual muscle testing showed no deficits in strength as well, all received a 5/5. Neurological
and circulation tests were within normal limits. In order to make a proper diagnosis special tests
were done. An Anterior Drawer (tests the integrity of the ATF, and CF), and Talor Tilt (tests the
integrity of the ATF, and CF) tests came back positive. Compression, tap (both used for
fractures), and Kleiger’s (used for deltoid and syndesmosis joint) were all negative. At this point
he was referred to get an X-ray, which also came back negative.
Clinical Impression
The impression I got from the assessment is that this athlete suffered a 2nd degree lateral or
inversion ankle sprain. This sprain affected the ATF and CF ligaments. I came to this conclusion
because the pain he was complaining of was localized over the sinus tarsi area, which holds the
ATF, and the CF area was also sore. The special tests that came back positive were indicative of
a 2nd degree ankle sprain. The fact that he had a previous injury to his right ankle before is a big
red flag to me as well. Since lateral ankle injuries can become chronic, I am pretty confident in
saying that he had a 2nd degree ankle sprain affecting the ATF and CF.
Initial Management
Directly following the injury evaluation of the ankle, treatment for the athlete begins. Treatment
for the injury depends solely on the injury itself. The first line of defense is PRICE (protection,
rest, ice, compression, and elevation), followed closely by cryotherapy, or ice therapy (Ivins).
The athlete was not allowed to return to activity until he was able to pass a return to activity
physical assessment. He was put in a boot right away to help with the compression. Later that
same boot helped to control the rapid swelling that appeared the day after the injury. Along with
the boot they cut out a horseshoe pad for that ankle to give the lateral ankle support and
cushioning. For the first two weeks after the injury he was put into a whirlpool ice bath, and after
two weeks began a rehabilitation program. His rehabilitation program was centered on gaining
balance and stability back to the injured ankle. Every other day until he was able to return to
activity he did exercises. In the beginning he started with picking up small objects off the ground
with his feet, doing open-chain exercises (using resistive bands), and proprioceptive exercises
(using stability plates). As he progressed he moved to more closed-chain exercises that were
more functionally based, along with sport specific exercises like calf raises (Osborne).
Rehabilitation Progress
As he went through the program he gained strength and stability in the right ankle. He did go on
to finish the season, about 4 to 5 weeks after the injury occurred he went back to full activity. He
reached all goals that were set forth for him to accomplish during rehabilitation, he gained
stability, strength, and eliminated the pain, swelling, and eccyhmosis as well. At the start of this
season he was back in the Athletic Training room. To make sure that he does not injure his ankle
again he was there doing stabilization exercises and strengthening exercises. He has taken it
upon himself to prevent another injury like that from happening.
Criteria for Return
In order for the athlete to return back to play he had to complete a physical test to make sure he
was ready to go back. In this case he had to prove that he had complete stability and strength
back to the right ankle. He had to do a jumping exercise on a trampoline and had to complete calf
raises, just like his rehabilitation program but, without shaking or loosing balance. Lateral /
inversion ankle sprains are not always the same and for different sports the examiner should do
sport specific exercises to make sure an athlete can return to play. For instance if the injured
athlete is a soccer player, the examiner should have them do some cutting drills successfully
before he or she allows them to return to full activity. An athlete with an ankle injury should only
return to play though when they feel they are fully ready to compete at the level they did before
the injury to prevent another injury from occurring.
Summary
The athlete involved in this case study showed that he had the drive and patience to do what he
needed to in order to return to play safely. He went through his full rehabilitation program and
made his ankle more stabile and stronger in the process. By coming in before the season started
this winter he showed that he was serious about preventing this injury from happening again.
Many people would brush off an ankle injury until it became too late, and that’s the worst thing
you can do. As I said ankle injuries can turn chronic and by keeping your ankles strong and
doing stabilization exercises these injuries can be reduced.
Works Cited
Fong, Daniel Tik-Pui. "A Systematic Review on Ankle Injury and Ankle Sprain in
Sports." Sports Med 37(2007): 73-94.
Ivins, Douglas. "Acute Ankle Sprain: An Update." American Academy of Family
Physicians. 74(2006): 1714-1720.
Lynam L, EN623. "Assessment of acute foot and ankle sprains." Emergency Nurse
14(2006): 24-33.
Osborne, Micheal D.. "Prevention and Treatment of Ankle Sprain in Athletes." Sports
Med 33(2003): 1145-1150.
Starkey, Chad, and Jeff Ryan. Evaluation of Orthopedic and Athletic Injuries. 2nd ed.
Philadelphia: F. A. Davis Company, 2002.