eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Ankle Sprain: Differential Diagnoses & Workup

Author: Marlon P Rimando, MD, Assistant Clinical Professor, Department of Medicine, University of Hawaii
Contributor Information and Disclosures

Updated: Jun 20, 2008

Differential Diagnoses

Achilles Tendon Injuries and Tendonitis
Complex Regional Pain Syndromes
Navicular Fracture
Postexercise Muscle Soreness
Stress Fracture

Other Problems to Be Considered

Distal fibula fracture
Fifth metatarsal fracture
Peroneal tendon dislocation
Acute gout exacerbation

Related eMedicine topics:
Peroneal Tendon Pathology
Peroneal Tendon Syndromes

Workup

Laboratory Studies

  • Lab tests typically are not necessary for acute ankle sprains related to trauma or sports injury. Obtain appropriate studies if a rheumatologic condition is suggested.

Imaging Studies

  • Plain films of the ankle are not always necessary.8 Stress radiographic films may provide further assessment for ankle stability; however, patient cooperation may be limited, depending on the severity of the injury. Obtain radiographs in the following situations:
    • Bone tenderness is evidenced on palpation of the navicular, the base of the fifth metatarsal bones, or the posterior edge or tip of the medial or lateral malleolus.
    • The patient shows an inability to bear weight, which should alert the clinician to a possible fracture.
  • Computed tomography (CT) scanning may be indicated if imaging of soft tissues is warranted or if bone imaging beyond radiography is indicated. In complex injuries, 3-dimensional CT scanning may be useful.
  • Magnetic resonance imaging (MRI) may be useful when osteochondrosis or meniscoid injury is suspected in patients with a history of recurrent ankle sprains and chronic pain.9
  • A bone scan can detect subtle bone abnormalities (eg, stress fracture, osteochondral defects). A bone scan can also detect syndesmotic disruption.

Other Tests

  • Arthroscopy of the ankle may be used diagnostically and therapeutically in subacute or chronic ankle problems. Arthroscopy is indicated if osteophytes, meniscoid lesions, foreign bodies, or osteochondral defects are present.

More on Ankle Sprain

Overview: Ankle Sprain
Differential Diagnoses & Workup: Ankle Sprain
Treatment & Medication: Ankle Sprain
Follow-up: Ankle Sprain
Multimedia: Ankle Sprain
References
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References

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  2. Singer KM, Jones DC. Ligament injuries of the ankle and foot. In: Nicholas JA, Hershman EB, eds. The Lower Extremity and Spine in Sports Medicine. vol 2. 2nd ed. St Louis, Mo: Mosby; 1995:475-97.

  3. Windsor RE. Overuse injuries of the leg, ankle and foot. Phys Med Rehabil Clin North Am. 1994;195-214.

  4. Ivins D. Acute ankle sprain: an update. Am Fam Physician. Nov 15 2006;74(10):1714-20. [Medline]. [Full Text].

  5. LeBlanc KE. Ankle problems masquerading as sprains. Prim Care. Dec 2004;31(4):1055-67. [Medline].

  6. Gross MT, Liu HY. The role of ankle bracing for prevention of ankle sprain injuries. J Orthop Sports Phys Ther. Oct 2003;33(10):572-7. [Medline].

  7. Brown C, Padua D, Marshall SW, et al. Individuals with mechanical ankle instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers. Clin Biomech (Bristol, Avon). Jul 2008;23(6):822-31. [Medline].

  8. Singh-Ranger G, Marathias A. Comparison of current local practice and the Ottawa Ankle Rules to determine the need for radiography in acute ankle injury. Accid Emerg Nurs. Oct 1999;7(4):201-6. [Medline].

  9. Bencardino J, Rosenberg ZS, Delfaut E. MR imaging in sports injuries of the foot and ankle. Magn Reson Imaging Clin N Am. Feb 1999;7(1):131-49, ix. [Medline].

  10. Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. J Athl Train. Sep 2004;39(3):278-9. [Medline]. [Full Text].

  11. Rehabilitation of the ankle and foot. In: Kibler WB, Herring SA, Press JM, eds. Functional Rehabilitation of Sports and Musculoskeletal Injuries. Gaithersburg, Md: Aspen Pub; 1998:273-9.

  12. Laufer Y, Rotem-Lehrer N, Ronen Z, et al. Effect of attention focus on acquisition and retention of postural control following ankle sprain. Arch Phys Med Rehabil. Jan 2007;88(1):105-8. [Medline].

  13. Man IO, Morrissey MC. Relationship between ankle-foot swelling and self-assessed function after ankle sprain. Med Sci Sports Exerc. Mar 2005;37(3):360-3. [Medline].

  14. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. [Medline].

  15. Curtis CK, Laudner KG, McLoda TA, et al. The role of shoe design in ankle sprain rates among collegiate basketball players. J Athl Train. May-Jun 2008;43(3):230-3. [Medline]. [Full Text].

  16. Fong DT, Man CY, Yung PS, et al. Sport-related ankle injuries attending an accident and emergency department. Injury. Jun 5 2008;[Medline].

  17. Foster AP, Thompson NW, Crone MD, et al. Rupture of the tibialis posterior tendon: an important differential in the assessment of ankle injuries. Emerg Med J. Dec 2005;22(12):915-6. [Medline].

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Further Reading

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Keywords

ankle sprain, ankle strain, inversion ankle injury, eversion ankle injury, ankle pain, lateral ankle complex, talofibular ligament, calcaneofibular ligament, posterior talofibular ligament

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Contributor Information and Disclosures

Author

Marlon P Rimando, MD, Assistant Clinical Professor, Department of Medicine, University of Hawaii
Marlon P Rimando, MD is a member of the following medical societies: National Strength and Conditioning Association
Disclosure: Nothing to disclose.

Medical Editor

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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