eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Acute Ankle Sprains: Workup

Author: Ray Foster, MD, FACS, Medical Staff Physician, Black Hills Health and Education Center
Contributor Information and Disclosures

Updated: Apr 30, 2009

Workup

Laboratory Studies

  • No laboratory studies are indicated for isolated ankle sprains.

Imaging Studies

  • Radiography
    • Plain radiographs may be clinically indicated to diagnose a fracture of the ankle or foot.
    • Ankle stress radiographs contribute little to the management of acute ankle sprains because surgical treatment of the acute sprain is rarely indicated. Abnormal swelling or clinical ankle instability in an acute sprain may be documented with bilateral stress radiographs of the ankle.
  • MRI
    • MRI is not indicated unless unusual features are present, such as extensive swelling, ecchymosis, or pain, that suggest an osteochondral lesion not observed on plain radiographs.
    • Initially, conservative ankle sprain treatment is indicated, even if MRI scans demonstrate bone bruising or actual articular cartilage damage.
  • Arthrogram
    • Ankle arthrograms may be useful for determining capsular damage and the number of ankle ligaments damaged; however, arthrography is indicated only if surgery is needed, and the criteria for surgery to repair double lateral ligament complete tears are still under debate. Staples found that arthrograms provide the most preoperative information.11,12
    • Ankle arthrograms are not indicated in every patient considered for surgical treatment. Marked clinical instability in a young individual with great physical demands being considered for surgery requires an ankle arthrogram.

Staging

  • Ankle sprains are classified into the following 3 grades:
    • Grade 1 is a symptomatic stretch within the tensile limit but without failure of the ligament fibers (tear).
    • Grade 2 exceeds the limits of tensile strength, with failure of part of the ligament fibers.
    • Grade 3 is complete failure of the ligament fibers.
  • Ankle sprains are primarily staged or graded clinically. The degree of swelling and ecchymosis and the clinical stability of the ankle determine whether the ankle ligaments are stretched without significant tear (grade 1), partially torn (grade 2), or completely torn (grade 3). Arthrograms, stress radiographs, and MRI scans add little to the management of the ordinary ankle sprain. In order to have any significance, stress radiographs should be performed on both ankles.

More on Acute Ankle Sprains

Overview: Acute Ankle Sprains
Workup: Acute Ankle Sprains
Treatment: Acute Ankle Sprains
Follow-up: Acute Ankle Sprains
Multimedia: Acute Ankle Sprains
References
Further Reading
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References

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Keywords

acute ankle sprain, turned ankle, stretched ankle, deltoid ligament sprain, anterior talofibular sprain, talofibular sprain, medial or lateral ankle sprains, distal talofibular syndesmotic sprain, high ankle sprain, inversion sprain, chronic ankle sprain, chronic ankle laxity, double ligament lateral ankle sprain, ankle pain, twisted ankle

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Contributor Information and Disclosures

Author

Ray Foster, MD, FACS, Medical Staff Physician, Black Hills Health and Education Center
Ray Foster, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

 
 
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