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. 2011 Sep;10(3):204-19.
doi: 10.1016/j.jcm.2011.02.001. Epub 2011 Jul 23.

Lateral and syndesmotic ankle sprain injuries: a narrative literature review

Affiliations

Lateral and syndesmotic ankle sprain injuries: a narrative literature review

Joshua C Dubin et al. J Chiropr Med. 2011 Sep.

Abstract

Objective: The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles.

Methods: Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing.

Discussion: Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care.

Conclusion: An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach.

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Figures

Fig 1
Fig 1
Basketball player sustaining a lateral ankle sprain.
Fig 2
Fig 2
Talocrural joint (indicated by red demarcation). ⁎⁎Also labeled are the fibula, tibia, anterior tibial tubercle, medial malleolus, lateral malleolus, and talus.
Fig 3
Fig 3
Range of motion of the TCJ. Each picture is labeled: left to right—plantar flexion, ground reactive dorsiflexion, neutral view. The neutral view labels the trochlea of the talus.
Fig 4
Fig 4
Subtalar joint (indicated by red demarcation).
Fig 5
Fig 5
Range of motion of the STJ (right foot). Each picture is labeled: left to right—inversion, neutral view (also identifies the talus and calcaneus), and eversion.
Fig 6
Fig 6
A, Lateral oblique view of the ankle joint. Identifies CFL, AITFL, and ATFL. B, Posterior view of the ankle joint. Identifies syndesmotic space, PITFL, and posterior talofibular ligament.
Fig 7
Fig 7
Peroneus longus and brevis muscles and tendons. Identifies lateral-view peroneus longus muscle and tendon, peroneus brevis muscle and tendon, and plantar-view continuation of the peroneus longus tendon.
Fig 8
Fig 8
Tibialis anterior muscle.
Fig 9
Fig 9
Mechanism of a lateral ankle sprain. Identifies injury of ATFL.
Fig 10
Fig 10
Mechanism of a syndesmotic sprain. Identifies injury of anterior tibiofibular ligament.
Fig 11
Fig 11
A, Proprioception training close to the center of gravity. B, Proprioception training with center of gravity shift.

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References

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