• An ankle sprain refers to tearing of the ligaments of the ankle.
  • The most common ankle sprain occurs on the lateral ankle. High ankle sprain affects the tibio-fibular syndesmosis.
  • Grade 1 – “twisted ankle” with mild pain and swelling. No loss of function.
  • Grade 2 – partial ligament tear with significant pain, swelling, bruising and loss of function.
  • Grade 3 – complete ligament tear unable to weightbear. Severe pain, swelling and bruising.

Diagnostic tips

  1. Pain and swelling of the ankle.
  2. Tenderness over the outer front aspect of the ankle.
  3. Difficulty walking (4 step rule).
  4. Bruising sometimes present.

Tests and Imaging

  1. Physical examination and history. Malleolar squeeze test for high ankle sprain.
  2. Grading of sprain.
  3. X-rays to exclude fracture if unable to walk 4 steps.
  4. MRI if complex injury is suspected.

Immediate Treatment

  1. R.I.C.E.R.
  2. Analgesia
  3. Crutches and ankle brace to limit inversion/eversion. Night splints may be helpful.

Possible Referral

  1. Podiatry for bracing, stabilisation, night splint, rehabilitation.
  2. Orthopaedic foot surgeon for patients who have recurrent ankle sprains due to ankle instability, andmay be candidates for ankle ligament stabilization.