University of Iowa Family Practice Handbook, Fourth Edition, Chapter 16

Orthopedics: Ankle Sprain

1. Clinical features. Sprains usually result from an inversion force; an eversion injury may result in a fracture. The most common ligament injured is the anterior talofibular ligament. A history of popping or a painful snap with ankle injury may be indicative of a significant ligament injury.
2. Radiography. The Ottawa ankle rules (Figure 16-1) have been developed and validated to determine who needs a radiograph. Using these rules, an occasional fracture will be missed. However, these are generally of no clinical significance (as with an avulsion injury). They apply only to an individual older than 17 years of age.
3. Treatment. In most ankle sprains, treatment includes external support such as the application of an air splint, ice application and elevation above the heart. NSAIDs or acetaminophen with or without hydro-codone or codeine can be used for pain control. The patient should be allowed partial weight bearing with crutches or a cane. Early mobilization and weight bearing hasten resolution. Patients with recurrent problems of instability or an acute grade III problem should be referred to an orthopedist for evaluation and the possibility of reconstructive surgery.

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See related Provider Topics Ankle Injuries and Disorders, Bones, Joints and Muscles, Injuries and Wounds or Sprains and Strains.

See related Patient Topics Ankle Injuries and Disorders, Bones, Joints and Muscles, Injuries and Wounds or Sprains and Strains.

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