What causes recurrent ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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The exact etiology of recurrent ankle sprains is unknown; however, many factors may play a role.

One possibility is that recurrent sprains result primarily from ligaments healing in a lengthened position due to scar tissue filling in the gap between the torn, separated ends. Furthermore, the weakness of the healed ligament may be due to the inherent weakness of the scar.

In a study by Bosien et al, 22% of patients with recurrent ankle sprains had persistent peroneal weakness. [16] The authors believed that this contributed to recurrent injury, especially in incompletely rehabilitated ankle sprains.

An unrecognized disruption of the distal tibiofibular ligament has been cited as a potential culprit. This condition is diagnosed based on tenderness over the anterior syndesmosis and pain when the fibula is squeezed against the tibia at midshaft, with dorsiflexion and external rotation or with excessive medial-lateral motion of the tibiotalar joint.

Freeman et al suspected that functional instability that resulted in recurrent sprains was secondary to loss of proprioception in the foot. [17] Mechanoreceptors and their afferent nerve fibers have been shown to exist in the ligaments and capsule of the ankle. Furthermore, disruption of the ligaments and joint capsule with a grade 3 sprain (a complete ligament tear; see Clinical Presentation) leads to impairment of the reflex stabilization of the foot, causing the foot to give way. [18] In addition, dysfunction of the peroneal nerve can result in delayed muscle response, causing a delay in the activation of the peroneal muscles and leading to functional instability.

Impingement by the distal fascicle of the AITF ligament and/or impingement of the capsular scar tissue in the talofibular joint is another cause, and hereditary hypermobility of joints is an additional suggested etiologic factor.

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