Stretch or tear of ankle ligaments, most commonly lateral (ATFL); from inversion injury.
History taking
- • Mechanism (inversion), audible pop, swelling, inability to bear weight
- • Prior sprains, sports activity
Examination
- • Inspection for swelling, ecchymosis
- • Palpation: ATFL, CFL, malleoli, fifth metatarsal base, navicular
- • Anterior drawer, talar tilt; Ottawa ankle rules to decide X-ray
Red flags
- • Inability to bear weight 4 steps + bony tenderness → consider fracture
- • Neurovascular compromise
Differential diagnosis
- • Ankle fracture, syndesmosis injury (high ankle sprain), Achilles tendon rupture, 5th metatarsal fracture
Recommended investigations
- • X-ray ankle if Ottawa rules positive
- • MRI for chronic instability
Diagnosis
- • Clinical grading I (stretch), II (partial tear), III (complete tear)
Initial treatment / management
- • PRICE: Protection, Rest, Ice, Compression, Elevation in first 48 h
- • Early functional mobilisation, ankle brace
- • NSAIDs short course
- • Physiotherapy for proprioception and strengthening
Prescription examples
- • Tab Naproxen 500 mg PO BD x 5 d
- • Topical Diclofenac gel TDS
- • Ankle support / brace for 2–3 weeks
Follow-up advice
- • Review in 2 weeks; if pain persists, exclude occult fracture
Patient counselling
- • Gradual return to sport with proprioception exercises
- • Use of brace during high-risk activities for 6 months
Referral criteria
- • Fracture, chronic instability, syndesmosis injury
Clinical pearls
- • Ottawa ankle rules safely reduce unnecessary X-rays
- • Functional treatment superior to immobilisation for most sprains
References
- • BMJ Best Practice: Ankle Sprain
- • AAOS Ankle Sprain Clinical Practice Guideline
Educational outpatient guide — verify against local guidelines before clinical use.
