Ankle region conditions: general considerations and management
Check for ‘red flag’ conditions (see Box 12.10).
Most ankle pain is mechanical in origin, often the result of trauma.
The most common acute ankle injury is a sprain of the lateral ligaments. This follows a plantar flexion inversion stress, in mild cases injuring the anterior capsule and anterior talofibular ligament at the anterolateral aspect of the joint. These injuries are accompanied by swelling, and often by bruising.
The need for X-ray is best determined by recourse to the Ottawa ankle rules.
These state that an ankle X-ray series is required only if there is any pain in the malleolar zone and it is accompanied by any of the following findings:
bony tenderness in the posterior edge of the fibula between the tip and a point 6 cm from the tip
bony tenderness in the posterior edge of the tibia between the tip and a point 6 cm from the tip
inability to weightbear, both immediately and in the emergency department.
For acute ligament sprains, initially use RICE therapy (see Table 12.11). Functional treatment using a lace-up or semi-rigid ankle support is preferable to use of an elastic bandage or tape.
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