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Ankle Sprains

Approximately 1 per 10,000 people per day get an ankle sprain in the United States ankle sprains, twisted ankle, sprain. Between 25,000 and upwards of 30,000 people are spraining their ankles on a daily basis, and our classification scale as probably most useful is grade I, II and III. Grade I, there has been an injury to the 

It might be microscopic, might be microscopic tearing or damage to the ligament, but macroscopically, the tendon is not elongated or grossly damaged, whereas grade II, there may be partial disruption or elongation and macroscopic tearing of the tendon versus grade III, when there is complete tear of the ligament. There is also the location, whether itís lateral, medial or does it involve the syndesmosis. Lateral ankle sprains are the most common injury, often a grade I or grade II, the foot is sort of in a plantar flexion, inverted position, and as we said before when I was talking about the anatomy slides when the ankle is plantar flexed, the anterior talofibular ligament assumes a more vertical orientation

Iitís functioning more as a true collateral ligament, and as the leg is rotated, and you are rolling over the foot, that is what is getting stress and it could be torn and an ankle sprain, so that patient is going to complain to you of swelling and tenderness, maybe even some ecchymosis on the lateral aspect of the ankle extending down onto the foot. I also find as a useful sign for me when I am trying to decide how severe the ankle sprain is, and how I am going to manage it, is also listening during the history of the examination. What were they able to do after they sprained their ankle? As general rule of thumb, I would tell you the patient probably has more soft tissue damage when he tells you a story of he or she was playing basketball, they went up for the basket and came down on their ankle and they couldnít move, their buddies had to carry them off the court, had to help them get to the hospital and they canít bear weight on their foot and is killing him, versus the person who tells you I twisted my ankle, I got up and finished what I was

I went to bed that night, and the next morning, thatís when my ankle was hurting me and I walked here to the emergency room or your office to be seen.

The chances are the less weight that was able to be placed after sustaining the ankle sprain, the more severe the injury.

You need to distinguish on your physical examination the bony and soft tissues, could you be missing a fracture in either the ankle or the foot. Are we sure about the soft tissues we are examining, is that really the calcaneal fibular ligament that is tender to palpation or am I pressing on the peroneal tendons because they are subluxating and they are hurting. Again, you need to examine the patient from their toes all the way up to their knee to make sure you are not missing any associated injuries to the

So whatís the treatment? Most in the vast, vast majority of ankle sprains can be treated nonoperatively and certainly they should be treated nonoperatively in the initial course of management. There really isnít a rule for repair of acute ankle sprains. Whatís the treatment protocol? Rest, ice, immobilization, compression and elevation trying to reduce the soft tissue swelling associated with a musculoskeletal injury. They need to be on protective weight bearing, because if the ligament is disrupted, itís going to 

As those ligaments go to heal down, and scar down, try to reform, you want to try to get them back as close as you can to their anatomical alignment and anatomic position with the least amount of elongation. So if you have someone with a severe ankle sprain, you think they really disrupted their anterior talofibular, you want to put them in a splint where their ankle is extremely plantar flexed, you are just increasing the gap between the anterior talofibular as you plantar flex the ankle. You donít want to