Sprained ankle - lateral and medial bruising

Findings

a) A history of an inversion sprain accompanied by plantar flexion, with rapid swelling. Bruising appears on both sides of the ankle, though, if only one capsule is strained and there has been no ligamentous tear, bruising can be absent.

b) The ankle is tender to palpation over the anterior talofibular ligament, middle talofibular ligament or calcaneofibular ligament.

c) Talar translation is painful, as is passive plantar flexion. If anterior translation is painful, it suggests that a combined lesion of lateral ligaments with a capsulitis or posterior tibiofibular ligament damage has occured.

d) Possible capsular signs from the ankle joint; extension and flexion hurt.

e) Calcaneotibial compression test is positive.

f) Bruising is lateral, posterior and medial.

g) There is often an effusion of the ankle joint.

Cause

The ankle ligaments are sprained or partially torn by an inversion and forced plantar flexion movement, so that the posterior capsule and posterior tibiofibular ligaments are damaged as well, plus the tissues at the posterior aspect of the ankle joint ar ecompressed and traumatized. There may also be a traumatic capsulitis present.

Treatment

a) As for unilateral swelling, but electrotherapy for the ankle joint, such as interferential and shortwave diathermy, will help.

b) Cortisone injection of the back of the ankle joint and posterior calcaneotibial space to settle tissue oedema. The injection may require repeating.

Sports

No sport is particularly causative, but these problems are common during training or returning to the sport after the injury:

a) Kicking, especially with the foot plantar flexed, as in the drive and volley(soccer). This problem persists after the acute phase has settled, until the injury has healed entirely. Strapping to limit plantar flexion may help.

b) A sudden stop to change direction, as in field hockey or squash, which forces posterior aspect of the calcaneum upwards against the tibia, is painful.

c) The accelerated, plantar flexion movement required for jumping is painful.

d) Dancing on pointes causes problems.

All may require an injection at the posterior aspect of the ankle to reduce inflammation and speed recovery. This injury takes more time to heal than unilateral bruising, often becoming a chronic ankle problem.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English