Pain after Lateral Ankle Sprain

 

Definition

 

Complex sprain 

- pain after ankle sprain

- suggests another injury

 

van Rijn et al Am J Med 2008

- sytematic review of 31 studies following acute lateral ligament injury

- up to 33% patients still have pain 1 year after acute ankle sprain

 

Differential diagnosis

 

1.  Soft tissue

- anterolateral impingement

- Bassett's ligament

 

2.  Bony Injury

- osteochondral lesion / loose body

- fracture anterior calcaneum / lateral process talus / sustenaculum tali

 

3.  Tendon / ligament

- high ankle sprain / syndesmotic injury

- peroneal dislocation / tears

- sinus tarsi syndrome

- Achilles tendonitis

 

Soft Tissue

 

Anterolateral impingement

 

Causes

- synovitis around torn or injured ATFL

- scarring in lateral gutter

 

Symptoms

- pain and swelling lateral gutter

 

Molloy test

- pain with dorsiflexion and pressure to anterolateral groove

 

Treatment

- ankle arthroscopy

- anterolateral tibio-talar synovectomy

 

Bassett's ligament

 

Thickened accessory (AITFL)

 

Bony Injury

 

Osteochondral lesion

 

Talus OCD Anterolateral 2Talus CT

 

www.boneschool.com/ankle-osteochondral-lesion

 

Fracture anterior process of calcaneum

 

Calcaneum Anterior Process FractureCalcaneum Anterior Process Non Union

 

www.boneschool.com/calcaneal-fractures-extra-articular

 

Fracture lateral process of talus

 

Lateral Process FractureLat process talus

 

www.boneschool.com/talar-body-fractures

 

Fracture Sustenaculum Tali

 

Sustenaculum Fracture CT 1Sustenaculum Fracture CT 2

 

www.boneschool.com/talar-body-fractures

 

Tendon / Ligament

 

High ankle sprain / syndesmotic injury

 

www.boneschool.com/high-ankle-sprain

 

 

 

Peroneal dislocation / tendonitis / tears

 

http://www.boneschool.com/peroneal-tendons

 

Sinus Tarsi Syndrome

 

Injury to interosseous ligament between talus and calcaneum

 

http://www.boneschool.com/sinus-tarsi-syndrome

 

Achilles tendonitis

 

http://www.boneschool.com/achilles-tendonitis