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- The most common causes of ankle sprains
are typically injuries with athletes
and people who are walking on uneven surfaces.
The most common ankles sprain that people see
is often one where the ankle rolls inwards
and it causes a tearing or stretching
of the ligaments on the outside of the ankle.
Ankle sprains could be classified in two ways.
The first is a lateral ankle sprain.
Which is the most common ankle sprain.
And there are typically three grades to those.
A Grade I is just a mild ligament injury
to the main ligament of the ankle,
called the anterior talofibular ligament.
The Grade II is typically a tearing or stretching
of that ligament plus another injury to a ligament
called the calcaneofibular ligament.
And then the Grade III sprain is typically
when there's severe tearing to the lateral ankle
structures where all three of the main ligaments
to the ankle on the outside of the joint are affected.
The second type of injury is called a high ankle sprain.
And that's typically when an injury occurs
to the ankle where the foot will turn outward.
And the ligaments are damaged that connect the two bones
of the leg called the tibia and the fibula together.
And those ligaments can either stretch or tear.
And that can be somewhat of a more debilitating injury
than your typical lateral ankle sprain.
And if those ligaments get torn
those two bones will piston and separate when you walk.
And that can cause a significant injury
to the point where it can need surgical correction.
Ankle sprains and the symptoms associated with them
are often very very similar.
You can see a Grade I ankle sprain
which will often appear with some swelling
on the outside of the ankle.
And obviously some bruising there.
The bruising can even extend to the toes
and even up in the leg and calf.
Depending on how much force the injury was sustained upon.
A stage two injury where there's some tearing
of the ligaments can lead to the point
where you have swelling which almost looks like
a golf ball or a grapefruit on the outside of the ankle.
And obviously that bruising will cause
much more significant color changes to the extremity
and it'll cause a lot more swelling to the extremity.
And the reason that that will swell much more
is because when the ligament's tear
the joint fluid can actually leave the ankle
and start to collect underneath the skin
and will cause a focal amount of swelling.
High ankle sprains will also show that amount
of swelling but oftentimes a high ankle sprain
will even cause a fracture to the upper bone of the leg
called a fibula, just below the knee.
So you can often see swelling from the knee
or the lower thigh down to the toes.
And the bruising can kind of follow
that swelling path as well.
Other symptoms include patient having a difficulty walking.
Especially on incline or decline.
Patient's will often describe a situation
where they have a difficult time going downstairs
but going up up the stairs
they have ability to be comfortable.
Many times with a Grade I or Grade II injury
the patient can walk flat-footed without pain
it's when they try to do any hyperextension
or hyperflexion that's when the injury
can become very very noticeable.
And it's often noted that when people
have ankle injuries the first three or four days
are the most painful because that's when the swelling
is really starting to penetrate the joint.
And as the body starts to adjust for the amount of swelling,
that's when the ankle injury will start to settle down.
And people can have these chronic ankle sprains
where they become repetitive injuries
and actually have no pain where their
ankle will buckle or turn
and they'll be sore for 24 to 48 hours.
Then after that they feel quite comfortable.
So we're gonna start our exam by looking at
the outside of your ankle.
Now the first thing we're gonna do
is palpate the three main ligaments
on the lateral aspect of the ankle.
The first one is here.
Called the anterior talofibular ligament.
And we're typically looking to see if the patient
has pain running from the outer knuckle of the ankle
to the main bone of the ankle called the talus.
And that's typically found where the patient has a
Grade I, Grade II, or Grade III ankle sprain.
The second spot that we're typically feeling for
is called the calcaneofibular ligament.
Which is immediately below the fibula,
and it runs behind a tendon
called a peroneal tendon structure.
So oftentimes the physician has to discern
whether the patient's having tendon pain
or ligament pain when we're palpating this area.
And finally we're gonna palpate the back of the joint
for the posterior talofibular ligament.
This ligament is the least common ligament
associated with an ankle sprain.
And it's typically only damaged
in a severe Grade III injury.
When somebody comes in with an ankle sprain
or a suspected ankle sprain.
The first question we always ask them
is what activity were they doing and how did they feel
or how did they interpret that their ankle twisted
when they came down on their ankle.
And most often patient's will state
that the ankle twisted inwards.
And again, that is kind of descriptive
of a lateral ankle sprain.
And once we get an idea of what activity
they were doing and the type of force
that was placed upon that ankle for the injury,
that will give us an idea of what structures were damaged.
After we look at these ligaments,
we're then gonna palpate our peroneal tendon structure.
And the peroneal tendons are two tendons
that run behind the ankle and they start from a muscle
on the upper outer portion of the leg
called the peroneal muscle.
And the peroneal muscle will form
two tendons that run behind the ankle.
And typically when a patient twists their ankle inwards,
this tendon can hit this bone and can cause a tendon injury.
And then we'll work our way to the inside of the ankle
where the deltoid ligament is.
It runs along the inner side of the ankle joint.
And we'll palpate those structures.
We'll then make sure that all of their tendons
and ligaments are intact.
And we'll do things such as an anterior drawer sign.
Where we'll pull their foot against their leg
to see if it slides.
And if it slides it's often indicative of a ligament tear.
And typically when we see a positive anterior drawer sign,
that's also the same patient that will come in
with a swelling to the outside of their ankle
that looks like a grapefruit or a golf ball.
Once we evaluate the outside and inside of the joint
I'll then test the patient's strength.
And we'll start out by having the patient
push down against my hand as hard as he or she can.
Then we'll have the patient pull up
as hard as he or she can.
Then push in.
And push out.
Often when a patient has an inside or an outside
ankle sprain or a lateral ankle sprain,
the patient will have a hard time pushing in and out.
And that can elicit pain.
And that's again, a pretty good indicator
of a soft tissue structure damage to the ankle.
One of the other least less common injuries
that people can see with an inversion injury
or twisting of the ankle is a cartilage tear.
And sometimes those don't show up on an x-ray.
So it's important to get a scan to see
if the cartilage is damaged as well as
if the the ligaments or tendons are torn.
- [Male] This is the front view of the left ankle.
This is a x-ray of the ankle.
This is the tibia.
This is the talus.
And this is the fibula.
These three bones are connected
by three sets of ligaments.
There is a ligament on the inner side here,
connecting the talus to the tibia.
There is a ligament here
that connects the tibia to the fibula.
And then finally there is a ligament
on the outside here that connects the fibula
to the talus.
It is this ligament,
the anterior talofibular ligament
that is the most commonly injured
or torn ligament of the ankle.
This occurs by what we call
an inversion injury to the ankle.
It is this ligament that we'll now look at
on an MRI.
This is an MRI of an ankle,
looking from the top down,
that is a cross section.
They chose a tear of a ligament
in the front of the ankle.
This is the leg bone.
And this is the bone called the fibula.
The ligament is in the front here
and the ligament should be a dark black.
This is normal ligament.
A tear, which is illustrated by the yellow arrow.
Is represented by a more greyish and white area.
So this is normal ligament.
And here is the tear here.
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