Ankle sprain

Question 1

Where do ankle sprains commonly occur?

Answer 1

-Lateral joint capsule
-Anterior talofibular ligament

Question 2

What signs indicate a fracture?

Answer 2

-If unable to weight bear immediately after fracture
-Crack / snap sound does not necessarily indicate a fracture

Question 3

What areas should be included in examination?

Answer 3

Examine from knee down:
-Proximal fibula
-Lateral malleolus and ligaments
-Medial malleolus and ligaments
-Navicular
-Calcaneum
-Achilles’ tendon
-Base of 5th metatarsal

Question 4

What patients would you x-ray?

Answer 4

Use Ottawa ankle rule - only x-ray if:
-Unable to weight bear for 4 steps
-Tenderness over L/M malleolus or navicular / base of 5th metatarsal
NB lower threshold for extremes of age or if intoxicated

Question 5

How would you manage an ankle sprain?

Answer 5

-Rest, elevation, ice, gentle exercise
-Simple analgesia
-Full recovery around 4 weeks
-Crutches if unable to weight bear
-If trouble weight bearing after 5 days - return to A+E