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CONDITION/DISORDER SYNONYMS
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Inversion ankle sprain
Lateral ankle sprain
ATFL sprain
ATFL tear
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PREFERRED PRACTICE PATTERN1
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4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction
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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.
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Disruption of anterior lateral ligament of the ankle
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
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Essentials of Diagnosis
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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)
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