eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Sprain: Differential Diagnoses & Workup

Author: Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Apr 28, 2009

Differential Diagnoses

Ankle Fracture
Ankle Impingement Syndrome
Calcaneofibular Ligament Injury
Peroneal Tendon Syndromes
Talofibular Ligament Injury

Other Problems to Be Considered

Ankle instability
Calcaneus bone injuries
Referred pain from midfoot and forefoot
Subtalar joint sprain or instability
Tumors

Related eMedicine topics:
Ankle, Fractures [in the Radiology section]
Calcaneus, Fractures
Dislocations, Foot
Fractures, Ankle [in the Emergency Medicine section]
Fractures, Foot
Osteochondritis Dissecans [in the Radiology section]
Osteochondritis Dissecans [in the Orthopedic Surgery section]
Talus, Fractures

Workup

Laboratory Studies

  • Laboratory studies are not indicated for the diagnosis of ankle sprain injuries.

Imaging Studies

  • Plain radiography
    • If the athlete is aged 18-65 years, consider the Ottawa ankle rules when deciding whether to obtain a plain radiograph or not.16,17,18 These guidelines state that an examiner is unlikely to miss a clinically significant fracture if the patient has no bony tenderness and can bear weight for at least 4 steps. Obtain a radiograph if either of the following situations occurs:
      • The history or physical is clinically suspicious for an injury other than an ankle sprain
      • Injuries have been diagnosed as ankle sprains but are not improving as would be expected  
    • Stress radiographs are rarely needed to evaluate ankle injuries. However, in cases of a chronic ankle instability that is not responding to treatment, a stress radiograph may be considered. Stress views include the talar tilt test and anterior drawer test (see Clinical, Physical, above). Because of the high variability of normal ankle laxity, comparison views of the uninjured side are usually needed. Although the figures used by clinicians vary, generally a 3-5º difference more in laxity than the uninjured side or an absolute value of 10º is considered a positive finding.
  • Bone scanning is useful for evaluating stress fractures, infections, and tumors.
  • Computed tomography (CT) scanning is useful for evaluating osteochondritis dissecans (OCD) and stress fractures.
  • Magnetic resonance imaging (MRI) is useful for evaluating OCD, fractures, ankle impingement, and soft-tissue injuries.

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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Further Reading

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Keywords

ankle sprain, sprained ankle, twisted ankle, ankle injury, rolled ankle, anterior talofibular ligament sprain, deltoid ligament sprain, high ankle sprain, lateral ankle sprain, medial ankle sprain, syndesmosis sprain, turned ankle

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Contributor Information and Disclosures

Author

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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