Which physical findings are characteristic for ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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The physical examination confirms a diagnosis made on the basis of patient history and differentiates an ankle sprain from a fracture. The examiner should look for areas of tenderness and swelling. The maximal points of tenderness for a lateral ankle sprain should be at the ATFL and/or CFL ligament areas.

Ecchymosis may be present and may be tender. The degree of swelling or ecchymosis may be proportional to the likelihood of fracture. Note, however, that blood usually settles along the medial or lateral aspects of the heels. Thus, the location of the ecchymosis may not correlate with the location of the injury. In addition, prompt treatment with ice, compression, and elevation of the ankle may reduce swelling and ecchymosis; thus, these findings do not necessarily correlate with the severity of the injury.

No bony point tenderness should be present; particular attention should be given to the medial malleolus, lateral malleolus, base of the fifth metatarsal, and midfoot bones. Point bony tenderness at one of these areas, as well as bony deformity or crepitus, suggests the possible presence of a fracture.

Pain localized to the medial aspect of the ankle suggests a medial ankle sprain. Active ROM must be assessed, because Achilles tendon ruptures can mimic ankle sprains. In lateral sprains, passive inversion should reproduce the symptoms. Plantar flexion should also exacerbate the symptoms, because this motion stretches the ATFL to its maximum.

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