Lateral Ankle Sprains [Evidence Based Guide for Physical Therapists] Anatomy, Diagnosis, Differential Diagnosis | FPF Show Episode 86

By dpope2020

June 2, 2023

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Lateral Ankle Sprains [Evidence Based Guide for Physical Therapists] Anatomy, Diagnosis, Differential Diagnosis | FPF Show Episode 86

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Evidence Based Lateral Ankle Sprain "Cheat Sheet" for Clinicians

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In today's episode we go over an Evidence Based Guide to Lateral Ankle Sprains for Physical Therapists | Anatomy, Diagnosis, Differential Diagnosis | FPF Show Episode 86:

Welcome, coaches and clinicians, to this comprehensive guide on lateral ankle sprains.

It is vital to have a solid understanding of the anatomy, diagnostic procedures, and differential diagnosis of this common injury. This evidence-based guide aims to enhance your knowledge and provide practical insights to effectively manage lateral ankle sprains in your patients.

1: Anatomy of the Lateral Ankle: Understanding the anatomy of the lateral ankle is crucial in diagnosing and treating lateral ankle sprains.

  • Ligamentous Structures:The lateral ankle ligaments include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The ATFL is the most commonly injured ligament in lateral ankle sprains.
  • Muscular Support: The peroneus brevis and peroneus longus muscles provide dynamic stability to the lateral ankle. Assessing their strength and function is essential during diagnosis.

2: Diagnosis of Lateral Ankle Sprains: Accurate diagnosis of lateral ankle sprains is essential for effective management. The following steps can guide your diagnostic process:

  • Patient History: Take a thorough history, including the mechanism of injury, previous ankle injuries, and any associated symptoms such as pain, swelling, or instability.
  • Physical Examination: Perform a systematic examination, including inspection, palpation, range of motion assessment, and stress testing. Special tests such as the anterior drawer test and talar tilt test can help confirm the diagnosis.
  • Imaging: Consider imaging modalities such as radiographs (X-rays) to rule out fractures or other bony pathologies if you have a positive Ottawa Ankle Rule. MRI scans may be necessary if there is suspicion of associated ligamentous or tendon injuries.

3: Differential Diagnosis of Lateral Ankle Sprains: It is essential to differentiate lateral ankle sprains from other conditions that may present with similar symptoms. Consider the following differential diagnoses:

  • Syndesmotic (High Ankle) Sprains: Distinguish lateral ankle sprains from syndesmotic sprains, which involve the ligaments connecting the tibia and fibula. Pain and tenderness above the ankle joint, pain with external rotation, and positive special tests, such as the external rotation stress test, suggest a syndesmotic sprain.
  • Fractures: Fractures of the ankle or foot bones can mimic the symptoms of a lateral ankle sprain. Radiographic imaging is crucial to identify fractures, particularly avulsion fractures of the lateral malleolus, navicular or fifth metatarsal fractures.
  • Tendon Injuries: Injuries to the peroneal tendons, such as tears or subluxations, can present with lateral ankle pain and instability. Be on the lookout for these issues.

In today's video we go over anatomy, diagnosis and differential diagnosis in part 2 of our evidence based guide to lateral ankle sprains:

The diagnosis is apparent, it's ankle pain syndrome...

- Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

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Dan Pope DPT, OCS, CSCS

References: 

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  12. Ankle Sprain Image: 

    1. URL: https://commons.wikimedia.org/wiki/File:Ankle_sprain_6_--_Smart-Servier.png 

    2. Attribution: Laboratoires Servier, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

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  15. Ankle Sprain Image: URL: https://commons.wikimedia.org/wiki/File:Sprained_foot.jpg Attribution: Boldie, Public domain, via Wikimedia Commons

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