injuries poisoning
Ankle Sprains
Introduction
Ankle sprains are very common, most often resulting from turning the foot inward (inversion). Common findings are pain, swelling, and tenderness, which are maximal at the anterolateral ankle. Diagnosis is by clinical evaluation and sometimes x-rays. Treatment is protection, rest, ice, compression, and elevation (PRICE) and early weight bearing for mild sprains and immobilization followed by physical therapy for moderate and severe sprains; some very severe sprains require surgical repair. (See also Overview of Sprains and Other Soft-Tissue Injuries .) The most important ankle ligaments are the following: Deltoid (the strong, medial ligament) Anterior and posterior talofibular (lateral ligaments) Calcaneofibular (lateral ligaments—see figure) Inversion(turning the foot inward) tears the lateral ligaments, usually beginning with the anterior talofibular ligament. Most tears result from inversion. Severe 2nd- and 3rd-degree sprains sometimes cause chronic joint instability and predispose to additional sprains. Inversion can also cause talar dome fractures, with or without an ankle sprain. Eversion(turning the foot outward) stresses the joint medially. This stress often causes an avulsion fracture of the medial malleolus rather than a ligament sprain because the deltoid ligament is so strong. However, eversion can also cause a sprain. Eversion also compresses the joint laterally; this compression, often combined with dorsiflexion, may fracture the distal fibula or tear the syndesmotic ligaments between the tibia and fibula just proximal to the ankle (called a high ankle sprain). Sometimes eversion forces are transmitted up the fibula, fracturing the fibular head just below the knee (called a Maisonneuve fracture). Recurrent ankle sprains can damage ankle proprioception and thus predispose to future ankle sprains. Most ankle sprains are mild (1st- or 2nd-degree). 