Skip to main content
SpringerLink
Log in

Acute Ankle Instability/Ankle Sprains in Athletes

  • Chapter
  • First Online:
Foot and Ankle Sports Orthopaedics

  • 2569 Accesses

Abstract

Ankle ligament injuries are common amongst athletes. Low ankle sprains typically involve the anterior talofibular ligament and the calcaneofibular ligament while high ankle sprains involve the syndesmosis. These injuries present with focal tenderness, swelling over the involved ligaments, and pain with weight bearing. Specialized physical exam maneuvers and radiographic imaging can aid in the diagnosis of these injuries. Non-operative management includes immobilization followed by stretching, proprioception training and peroneal strengthening. Furthermore, ankle braces and proprioception training prevent repeat injury. Surgical management includes multiple procedures ranging from ankle arthroscopy to anatomic reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fong DT, Chan YY, Mok KM, Yung PS, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:14. doi:10.1186/1758-2555-1-14.

    PubMed  PubMed Central  Google Scholar 

  2. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42:311–9.

    PubMed  PubMed Central  Google Scholar 

  3. Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in national hockey league players. Am J Sports Med. 2004;32:1941–5.

    PubMed  Google Scholar 

  4. Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. 1989;17:282–5.

    Article  CAS  PubMed  Google Scholar 

  5. Ferran NA, Mauffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006;11:659–62.

    Article  PubMed  Google Scholar 

  6. Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19:653–60.

    Article  CAS  PubMed  Google Scholar 

  7. Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Spec. 2014;7:37–44.

    Article  PubMed  Google Scholar 

  8. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44:123–40.

    Article  PubMed  Google Scholar 

  9. van den Bekerom MP, Lamme B, Hogervorst M, Bolhuis HW. Which ankle fractures require syndesmotic stabilization? J Foot Ankle Surg. 2007;46:456–63.

    Article  PubMed  Google Scholar 

  10. Burks RT, Morgan J. Anatomy of the lateral ankle ligaments. Am J Sports Med. 1994;22:72–7.

    Article  CAS  PubMed  Google Scholar 

  11. Stephens MM, Sammarco GJ. The stabilizing role of the lateral ligament complex around the ankle and subtalar joints. Foot Ankle. 1992;13:130–6.

    Article  CAS  PubMed  Google Scholar 

  12. Funk JR, Hall GW, Crandall JR, Pilkey WD. Linear and quasi-linear viscoelastic characterization of ankle ligaments. J Biomech Eng. 2000;122:15–22.

    Article  CAS  PubMed  Google Scholar 

  13. Attarian DE, McCrackin HJ, DeVito DP, McElhaney JE, Garrett WE. Biomechanical characteristics of human ankle ligaments. Foot Ankle. 1985;6:54–8.

    Article  CAS  PubMed  Google Scholar 

  14. Siegler S, Block J, Schneck CD. The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle. 1988;8:234–42.

    Article  CAS  PubMed  Google Scholar 

  15. Parenteau CS, Viano DC, Petit PY. Biomechanical properties of human cadaveric ankle-subtalar joints in quasi-static loading. ASME J Biomech Eng. 1998;120:105–11.

    Article  CAS  Google Scholar 

  16. Cass JR, Settles H. Ankle instability: in vitro kinematics in response to axial load. Foot Ankle Int. 1994;15:134–40.

    Article  CAS  PubMed  Google Scholar 

  17. Fuller EA. Center of pressure and its theoretical relationship to foot pathology. J Am Podiatr Med Assoc. 1999;89:278–91.

    Article  CAS  PubMed  Google Scholar 

  18. Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech. 2000;33:513–9.

    Article  CAS  PubMed  Google Scholar 

  19. Ashton-Miller JA, Ottaviani RA, Hutchinson C, Wojtys EM. What best protects the inverted weightbearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses. Am J Sports Med. 1996;24:800–9.

    Article  CAS  PubMed  Google Scholar 

  20. Snedden MH, Shea JP. Diastasis with low distal fibula fractures: an anatomic rationale. Clin Orthop Relat Res. 2001;382:197–205.

    Article  Google Scholar 

  21. Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006;36:372–84.

    Article  PubMed  Google Scholar 

  22. Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15:330–9.

    Article  PubMed  Google Scholar 

  23. Anderson R, Hunt K, McCormick J. Management of common sports related injuries about the foot and ankle. J Am Acad Orthop Surg. 2010;18:546–56.

    Article  PubMed  Google Scholar 

  24. Nitz AJ, Dobner JJ, Kersey D. Nerve injury and grades II and III ankle sprains. Am J Sports Med. 1985;13:177–82.

    Article  CAS  PubMed  Google Scholar 

  25. Harmon KG. The ankle examination. Primary Care Clin Office Pract. 2004;31:1025–37.

    Article  Google Scholar 

  26. Stiell I. Ottawa ankle rules. Can Fam Physician. 1996;42:478–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Hertel J. Functional anatomy, pathomechanics and pahtophysicology of lateral ankle instability. J Athl Train. 2002;37:364–75.

    PubMed  PubMed Central  Google Scholar 

  28. Fincher AL. Early recognition of syndesmotic ankle sprains. Athl Ther Today. 1999;4:42–3.

    Article  Google Scholar 

  29. Brosky T, Nyland J, Nitz A, Caborn DN. The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther. 1995;21:197–205.

    Article  CAS  PubMed  Google Scholar 

  30. Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18:693–8.

    Article  CAS  PubMed  Google Scholar 

  31. Miller CD, Shelton WR, Barrett GR, Savoie FH, Dukes AD. Deltoid and syndesmosis ligament injury of the ankle without fracture. Am J Sports Med. 1995;23:746–50.

    Article  CAS  PubMed  Google Scholar 

  32. Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10:156–60.

    Article  CAS  PubMed  Google Scholar 

  33. Clanton TO. Athletic injuries to the soft tissues of the foot and ankle. In: Coughlin MJ, Mann RA, editors. Surgery of the foot and ankle. Mosby: St Louis; 1999. p. 1090–209.

    Google Scholar 

  34. Kaikkonen A, Kannus P, Jarvinen M. A performance test protocol and scoring scale for the evaluation of ankle injuries. Am J Sports Med. 1994;22:462–9.

    Article  CAS  PubMed  Google Scholar 

  35. Porter DA. Ligamentous injuries of the foot and ankle. In: Fitzgerald RH, Kaufer H, Malkani AL, editors. Orthopaedics. St. Louis: Mosby; 2002.

    Google Scholar 

  36. Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33:371–8.

    Article  PubMed  Google Scholar 

  37. Maffulli N, Ferran N. Management of acute and chronic ankle instability. J Am Acad Orthop Surg. 2008;16:608–15.

    Article  PubMed  Google Scholar 

  38. Ardèvol J, Bolíbar I, Belda V, Argilaga S. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc. 2002;10:371–7.

    Article  PubMed  Google Scholar 

  39. Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2002;3:CD003762.

    Google Scholar 

  40. Kerkhoffs GM, Struijs PA, Marti RK, Blankevoort L, Assendelft WJ, van Dijk CN. Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review. Acta Orthop Scand. 2003;74:69–77.

    Article  PubMed  Google Scholar 

  41. Laver L, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-014-3119-x.

    PubMed  Google Scholar 

  42. Berlet GC, Landis GS, Hyer CF, Philbin TM. Anatomic repair of lateral ankle instability. In: Wiesel SW, editor. Operative techniques in orthopaedic surgery. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 4314–21. Print.

    Google Scholar 

  43. Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN. Operative and functional treatment of rupture of the lateral ligament of the ankle: a randomised, prospective trial. J Bone Joint Surg Br. 2003;85:525–30.

    Article  CAS  PubMed  Google Scholar 

  44. Hepple S, Guha A. The role of ankle arthroscopy in acute ankle injuries of the athlete. Foot Ankle Clin. 2013;18:185–94. doi:10.1016/j.fcl.2013.02.001.

    Article  PubMed  Google Scholar 

  45. Kemonda GA, Ferkel RD. Arthroscopic findings associated with the unstable ankle. Foot Ankle Int. 1999;20:708–13.

    Article  Google Scholar 

  46. Mattacola CG, Dwyer MK. Rehabilitation of the ankle after acute sprain or chronic instability. J Athl Train. 2002;37:413–29.

    PubMed  PubMed Central  Google Scholar 

  47. Edelstein J, Noonan D. Lateral ankle reconstruction. In: Mosca JC, Cahill J, Young C, editors. Postsurgical rehabilitation guidelines for the orthopedic clinician. Philadelphia: Mosby, Inc; 2006. Print.

    Google Scholar 

  48. Thonnard JL, Bragard D, Willems PA, Plaghki L. Stability of the braced ankle: a biomechanical investigation. Am J Sports Med. 1996;24:356–61.

    Article  CAS  PubMed  Google Scholar 

  49. Tropp H, Askling C, Gillquist J. Prevention of ankle sprains. Am J Sports Med. 1985;13:259–62.

    Article  CAS  PubMed  Google Scholar 

  50. Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, Horodyski M. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball: A randomized clinical study at West Point. Am J Sports Med. 1994;22:454–61.

    Article  CAS  PubMed  Google Scholar 

  51. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. 1994;22:601–6.

    Article  CAS  PubMed  Google Scholar 

  52. Laughman RK, Carr TA, Chao EY, Youdas JW, Sim FH. Three-dimensional kinematics of the taped ankle before and after exercise. Am J Sports Med. 1980;8:425–31.

    Article  CAS  PubMed  Google Scholar 

  53. Robbins S, Waked E, Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995;29:242–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Fumich RM, Ellison AE, Guerin GJ, Grace PD. The measured effect of taping on combined foot and ankle motion before and after exercise. Am J Sports Med. 1981;9:165–70.

    Article  CAS  PubMed  Google Scholar 

  55. Bahr R, Lian O, Bahr IA. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scand J Med Sci Sports. 1997;7:172–7.

    Article  CAS  PubMed  Google Scholar 

  56. Verhagen EA, van Mechelen W, de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med. 2000;10:291–6.

    Article  CAS  PubMed  Google Scholar 

  57. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. 2002; Issue 3:CD000380.

    Google Scholar 

  58. Handoll HHG, Rowe BH, Quinn KM, de Bie R. Interventions for preventing ankle ligament injuries. Cochrane Database of Syst Rev. 2001;Issue 3: CD000018.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC, 27703, USA

    Travis J. Dekker MD, Alexander J. Lampley MD, Jonathan A. Godin MD, MBA & Mark E. Easley MD

Authors
  1. Travis J. Dekker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander J. Lampley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan A. Godin MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark E. Easley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark E. Easley MD .

Editor information

Editors and Affiliations

  1. Swiss Medical Network Basel, Orthopaedic Department SWISS ORTHO CENTER Schmerzklinik Basel, Basel Stadt, Switzerland

    Victor Valderrabano

  2. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA

    Mark Easley

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Dekker, T.J., Lampley, A.J., Godin, J.A., Easley, M.E. (2016). Acute Ankle Instability/Ankle Sprains in Athletes. In: Valderrabano, V., Easley, M. (eds) Foot and Ankle Sports Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15735-1_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15735-1_27

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15734-4

  • Online ISBN: 978-3-319-15735-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation