eMedicine Specialties > Sports Medicine > Foot and Ankle

Calcaneofibular Ligament Injury: Differential Diagnoses & Workup

Author: Bryan L Reuss, MD, Orthopedic Surgeon, Orlando Orthopedic Center
Coauthor(s): Michael C Wadman, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, University of Nebraska College of Medicine; Randy Schwartzberg, MD, Director of Sports Medicine Education, Department of Orthopedic Surgery, Orlando Regional Healthcare System
Contributor Information and Disclosures

Updated: Jan 2, 2008

Differential Diagnoses

Ankle Fracture
Compartment Syndromes

Other Problems to Be Considered

Anterior talofibular ligament injury (See also the eMedicine article Talofibular Ligament Injury.)

Achilles tendon injury (See also the eMedicine articles Achilles Tendon Injuries and Tendonitis [in the Physical Medicine and Rehabilitation section], Achilles Tendon Pathology [in the Orthopedic Surgery section], and Achilles Tendon Rupture and Achilles Tendonitis [in the Sports Medicine section].)

Bifurcate ligament injury

Deep peroneal nerve injury

Dislocations, Ankle

Fifth metatarsal fracture (Jones fracture) (See also the eMedicine article Metatarsals, Fractures.)

Medial/deltoid ligament injury

Osteochondral fracture of talus (See also the eMedicine articles Osteochondral Lesions of the Talus [the Orthopedic Surgery section] and Talus, Fractures [in the Radiology section].)

Peroneal tendon dislocation/injury (See also the eMedicine article Peroneal Tendon Syndromes.)

Posterior talofibular ligament injury

Posterior tibial nerve injury

Superficial peroneal nerve injury

Sural nerve injury

Syndesmosis injury

Workup

Laboratory Studies

  • Laboratory studies are generally not needed in the assessment of an uncomplicated ankle inversion or CFL injury.

Imaging Studies

  • Obtain plain films of the injured ankle to detect any bony lesions.
  • Due to the high rate of ankle radiography (10% of all ED radiographs) but the relatively low incidence of ankle fractures, the Ottawa ankle rules were developed in an attempt to reduce costly and unnecessary ankle films.14 These rules consist of several simple clinical findings to help physicians in their decision to use radiographic studies for ankle inversion injuries.
    • In an inversion sprain, the Ottawa ankle rules determine that a radiographic series is only necessary if the patient has malleolar pain and either bone tenderness at the posterior edge or tip of the lateral malleolus or the inability to bear weight on the ankle.
    • Although the Ottawa ankle rules describe specific clinical situations in which radiographs are necessary, most clinicians choose to perform radiographic studies any time there is significant swelling, ecchymosis, or tenderness over the bony landmarks.
    • Most situations in which radiographs are necessary for ankle injuries require an anteroposterior (AP), lateral, and mortise view. These routine films must be examined for avulsion fractures, osteochondral injuries, and occult fractures.
  • Stress radiographs, ankle arthrograms, and magnetic resonance images (MRIs) can be helpful in the evaluation of high-performance athletes and surgical candidates, but these studies are rarely useful in the ED.
    • The talar tilt film is the stress film that is most beneficial for the diagnosis of a CFL injury/tear. An abnormal talar tilt angle indicates a probable CFL tear.
    • In ankle arthrograms, the joint capsule is most likely ruptured if the ankle joint accepts greater than the maximum allowable joint fluid volume (approximately 10 mL). In addition, CFL rupture can lead to extra-articular dye leakage into the peroneal tendon sheath.15
    • Many authors believe that MRI has surpassed all other imaging studies beyond the plain films due to its high level of visual technology and interpretive expertise.16 The major limitations to MRI use are cost, availability, and whether or not its findings lead to a change in the treatment course.
    • Obtaining an MRI without ever obtaining a plain radiograph is neither efficient nor helpful.

More on Calcaneofibular Ligament Injury

Overview: Calcaneofibular Ligament Injury
Differential Diagnoses & Workup: Calcaneofibular Ligament Injury
Treatment & Medication: Calcaneofibular Ligament Injury
Follow-up: Calcaneofibular Ligament Injury
Multimedia: Calcaneofibular Ligament Injury
References
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References

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Further Reading

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Keywords

ankle ligament injury, ankle injury, ligament injury, lateral ankle injury, sprain, ankle sprain, lateral ankle sprain, CFL injury

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Contributor Information and Disclosures

Author

Bryan L Reuss, MD, Orthopedic Surgeon, Orlando Orthopedic Center
Disclosure: Nothing to disclose.

Coauthor(s)

Michael C Wadman, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, University of Nebraska College of Medicine
Michael C Wadman, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Randy Schwartzberg, MD, Director of Sports Medicine Education, Department of Orthopedic Surgery, Orlando Regional Healthcare System
Randy Schwartzberg, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Florida Medical Association, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of California at Davis; Director of Amputee Clinic, Chief of Orthopedic Trauma, Kaiser Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Hungarian Medical Association of America, Orthopaedic Trauma Association, and Sierra Sacramento Valley Medical Society
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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