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  • Inversion ankle sprain

  • Lateral ankle sprain

  • ATFL sprain

  • ATFL tear


  • 845.0 Ankle sprain


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


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


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.



  • 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. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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