Acute ankle sprains are common injuries affecting over 2 million people a year in the United States. This injury can lead to short-term morbidity, recurrent injuries, and functional instability. Proper evaluation and treatment are essential to avoid long-term complications such as chronic instability or arthritis. The most commonly injured ligaments in ankle sprains are the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), with inversion and plantar flexion being typical mechanisms of injury.

Key Points:

• Most Common Injured Ligament: ATFL is the most frequently injured ligament, often due to plantar flexion and inversion. With severe injuries the calcaneofibular ligament CFL ligament and the posterior talofibular ligament PTFL ligament can be affected. Ligament injury can be graded I-III.
• Epidemiology: Ankle sprains are the most frequent injury in sports, with a high rate of recurrence, especially in athletes.
• Evaluation: The Ottawa ankle rules help determine when radiographs are necessary and are first line. Physical exams should include palpation of the ligaments and tests like the anterior drawer and talar tilt to assess stability. MRI may also be ordered for patients for further evaluation and surgical planning.
• Treatment: Early functional rehabilitation (including the PRICE protocol) is crucial for recovery. Compression, elevation, and gradual weight-bearing are part of the initial management, with strengthening exercises after the swelling subsides. Ankle braces, supportive shoe gear, and orthotics can be utilized to stabilize acute injuries and prevent future injuries. Physical therapy can also help rehab patients and prevent reinjury. Severe or recurrent sprains may require further treatment by a foot and ankle specialist. Severe injuries and those with continued instability may require surgical intervention.
• Prognosis: Most ankle sprains recover within 7-15 days, but up to 40% of individuals may experience recurrent instability, necessitating further intervention.

Complications to Watch For:

• Chronic pain, recurrent instability, osteochondral defects, and arthritis are potential long-term effects of ankle sprains.
• Ankle fractures and Maisonneuve Fractures: A severe injury mistaken for a sprain, often involving a fracture of the fibula distally or proximally requiring surgical fixation.

Effective team-based care and prompt intervention can reduce the risk of complications, ensuring better outcomes for patients with ankle sprains.