How is neurovascular compromise differentiated from an ankle sprain?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Neurovascular compromise

Suspect neurovascular compromise if the patient complains of a cold foot or describes paresthesias. [1] Bone tenderness in the posterior half of the lower 6 cm of the fibula or tibia and the inability to bear weight immediately after the injury and in the emergency department are indications to obtain radiographic imaging.

As with all limb injuries, the neurovascular status of the limb must be assessed. This assessment consists of palpation of the dorsalis pedis and posterior tibial arterial pulses. Testing for sensation, especially over the sural nerve distribution, is also necessary; sural nerve and peroneal nerve palsies, although rare, may complicate a lateral ligamentous injury. Electromyographic examinations of individuals with severe ankle sprains have shown that 80% of these patients have some degree of peroneal nerve injury.

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