What is the most common type of ankle injury?

Most Common Type of Ankle Injury

Lateral ankle sprains are the most common type of ankle injury, accounting for an estimated 2 million injuries per year and 20 percent of all sports injuries in the United States. 1

Epidemiology and Classification

• Ankle sprains are the most frequent cause of physician evaluation in sports medicine 2
• The lateral ligaments are most commonly injured, particularly the anterior talofibular ligament 3
• Lateral ankle sprains typically occur during plantar flexion and inversion movements, commonly described by patients as "rolling over" the outside of the ankle 4

Anatomy of Lateral Ankle Injuries

The lateral ligament complex includes three capsular ligaments:

• Anterior talofibular ligament (ATFL) - most commonly torn
• Calcaneofibular ligament (CFL)
• Posterior talofibular ligament (PTFL)

In severe inversion injuries, the subtalar joint ligaments may also be affected 4

Diagnosis

Clinical Assessment

• The Ottawa Ankle and Foot Rules can reduce unnecessary radiography in children and adults 1
• These rules have high sensitivity, missing fractures in only 0.3% of cases (47 out of 15,581 patients) 1
• Key clinical tests include:
  • Anterior drawer test to detect excessive anterior displacement of the talus
  • Talar tilt test to assess lateral ligament stability
  • Crossed-leg test to detect high ankle sprains 1

Imaging

• Radiographs are indicated based on Ottawa Ankle Rules to rule out fractures 3
• Advanced imaging (stress radiographs, arthrograms, MRI) may occasionally be needed for complex cases 2

Treatment

Acute Management

• The PRICE protocol (Protection, Rest, Ice, Compression, Elevation) is recommended for initial treatment 1, 5
• Cryotherapy (ice application) helps reduce edema and likely decreases pain and recovery time 1
• NSAIDs improve pain control and function, decrease swelling, and allow more rapid return to activity 1

Rehabilitation Approach

• Functional rehabilitation is superior to immobilization for ankle sprains 1

  • Patients undergoing functional treatment return to sports sooner (4.6 days earlier)
  • Patients return to work 7.1 days sooner than those treated with immobilization 1

• Comprehensive rehabilitation should include:

  • Range of motion exercises
  • Strengthening exercises (particularly for peroneal muscles)
  • Proprioceptive and balance training
  • Coordination exercises
  • Sport-specific exercises 5, 3

Support Devices

• Semirigid supports or braces are superior to elastic bandages 1, 5
• Braces or tape reduce the risk of recurrent inversion injuries (RR 0.53,95% CI 0.40 to 0.69) 1
• Based on practical usability and cost considerations, a brace is initially preferable to tape 1

Prevention of Recurrence

• Use of a brace or tape is recommended to prevent relapses, particularly for those with a history of recurrent sprains 1, 5
• Proprioceptive training on a tilt board after 3-4 weeks helps improve balance and neuromuscular control 4
• Implementation of proprioceptive and balance training programs is crucial to prevent persistent deficits 5

Common Pitfalls to Avoid

1. Excessive imaging when not indicated by Ottawa Ankle Rules 3
2. Unwarranted non-weight-bearing and unjustified immobilization 3
3. Delay in implementing functional movements 3
4. Inadequate rehabilitation leading to chronic instability 5
5. Neglecting proprioceptive training, which can lead to persistent deficits 5

By following an evidence-based approach to diagnosis and treatment of ankle sprains, clinicians can optimize outcomes and minimize the risk of chronic ankle instability and recurrent injuries.