Skip to Main Content

++

CONDITION/DISORDER SYNONYMS

++

  • Inversion ankle sprain

  • Lateral ankle sprain

  • ATFL sprain

  • ATFL tear

++

ICD-9-CM CODE

++

  • 845.0 Ankle sprain

++

ICD-10-CM CODE

++

  • S93.409A Sprain of unspecified ligament of unspecified ankle, initial encounter

++

PREFERRED PRACTICE PATTERN1

++

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

++

PATIENT PRESENTATION

Patient is a 31-year-old female. She bought a new pair of high heels and was walking in them when she turned her ankle inward and fell. Patient was able to walk home but could not wear the high heels. She saw the physician the next day who took x-rays that were negative. The physician placed her in a walking boot for 2 weeks to try and get some stability. Patient presents swelling, pain, and decreased mobility. She is still having difficulty with ambulation.

++

KEY FEATURES

++
Description
++

  • Disruption of anterior lateral ligament of the ankle

    • May be acute or chronic

  • The anterior talofibular ligament (ATFL) restricts anterior translation of the talus

  • The ATFL also restricts inversion and adduction at the subtalar joint

  • Most commonly injured with rapid inversion, adduction, and plantar flexion movements, in either contact or noncontact situations

  • Pain and edema at lateral ankle

  • Can occur with structure progression to the calcaneofibular (CF) ligament and then posterior talofibular ligament

++
FIGURE 203-1

Mechanism of inversion sprain. (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. http://www.accesspediatrics.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
++
Essentials of Diagnosis
++

  • Positive anterior drawer test and talar tilt test

  • Ultrasonography (US), radiography, or MRI may be utilized in select cases2

    • US or MRI is recommended following an inversion ankle sprain in a patient with chronic ankle instability

    • Radiographs utilized within the constraints of Ottawa ankle rules

    • ATFL tears are classified based on the anatomical degree of damage or functional stability found on clinical examination

    • Anatomical

      • Grade 1: Partial microscopic tearing of the ligament, minimal to no loss of function, mild swelling and pain

      • Grade 2: Partial macroscopic tearing of the ligament, with mild–moderate loss of function, moderate swelling/pain/tenderness

      • Grade 3: Complete rupture with severe loss of function, severe swelling/pain/tenderness

    • Functional stability

      • Stable: No laxity with talar tilt or anterior drawer testing (ATFL, Grade 1)

      • Unstable: Laxity with anterior drawer testing (ATFL, Grade 2); laxity with both anterior drawer and talar tilt (ATFL and CF, Grade 3)

++
FIGURE 203-2

Anterior drawer test. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.