Ankle sprains: a review of mechanism, pathoanatomy and management

Abstract

Ankle sprains are one of the most common musculoskeletal injuries. A sprain is defined as the stretching or tearing of ligaments; in the ankle these are the lateral ligamentous complex, deltoid ligament and distal tibiofibular syndesmosis ligaments. The mechanism of injury dictates which ligaments get injured, with the most common being inversion injuries causing anterior talofibular ligamentous sprain. Initial management of an ankle sprain consists of protection, rest, ice, compression and elevation. After the first 72 hours, the treatment depends on the severity of the sprain, with physiotherapy forming the mainstay of treatment in the majority of cases. In addition to strengthening exercises proprioceptive re-training helps with rehabilitation. The goal of treatment is to prevent chronic instability from occurring. Aside from syndesmotic injuries, surgical treatment is rarely required in the acute setting. Delayed ligamentous reconstruction may be required if chronic instability occurs, and is described as being an anatomic or non-anatomical reconstruction. This article reviews the anatomy, pathophysiology, clinical assessment and management of patients with ankle sprains.