Ankle Sprain Definition: causes elongation or tearing of one or more ligaments of the ankle joint, causing pain, swelling and difficulty walking.
Ankle sprains most often accumulate lateral collateral ligaments and ligamentous coalitions and may be associated with the following pathologic conditions including: osteochondral injury to the top of the talus, soft tissue impingement, ligamentous coalition injury, talar and heel synovial fractures, tarsal sinus syndrome, nerve injury, peroneal tendon injury, post-traumatic osteoarthritis, subtalar joint and ankle instability. These concomitant injuries correlate with the degree of sprain and with the outcome of treatment. Therefore, the accurate diagnosis and proper treatment of ankle sprains remains challenging. Patient knowledge of these can be helpful in treatment and rehabilitation.
Ankle sprains often involve the lateral collateral ligaments (anterior talofibular ligament, heel-fibular ligament, and posterior talofibular ligament) and the ligamentous union (anterior and posterior tibiofibular ligaments). The deltoid ligament is located in the medial ankle and is stronger than the ligaments in the lateral ankle and is relatively less prone to injury.
Ankle sprains account for 75% of ankle injuries, and plantarflexion with inversion or internal rotation of the foot is the most common mechanism of ankle injury. The lateral collateral ligaments are involved in approximately 85% of cases, with joint ligament sprains being the second most common, accounting for approximately 10%. The order of injury in ankle sprains is: first, tear of the anterior talofibular ligament; subsequently, the heel-fibular ligament; and, only in cases of extreme pronation, tear of the posterior talofibular ligament with avulsion fracture. Isolated heel-fibular ligament tears are rare.
Clinical grading of ankle sprains
Grading Ligament injury Clinical symptoms Time to recovery
Grade I Mild elongation Mild pain, swelling, and tenderness 1C3 weeks
No tears Generally no bruising or joint instability.
No difficulty in weight bearing walking
Grade II Partial tear Moderate pain, swelling, and tenderness 3C6 weeks
Possible bruising. Mild to moderate joint
instability . Some degree of ankle
Loss of motion and functional impairment.
Pain with weight bearing or walking
Grade 3 Complete tear Severe pain, swelling and tenderness and several months
bruising. A significant number of patients have ankle
instability. Loss of ankle motion and
functional impairment.
Inability to bear weight and walk
Grade I sprain: elongation of the anterior talofibular ligament and heel fibular ligament. Relative stability of the ankle joint:
Grade II sprain: partial tear of the anterior talofibular ligament and elongation of the heel fibular ligament. Produces varying degrees of ankle instability:
Grade III sprain: rupture of anterior talofibular ligament and heel fibular ligament, partial tear of posterior talofibular ligament and posterior tibiofibular ligament. Instability of the ankle joint may result in fracture of the surrounding bony structures.