Snapshot A 23-year-old man presents to the emergency department for ankle pain. He says that prior to symptom development, he was at soccer practice running exercise drills. He then rolled his ankle and subsequently developed severe pain. He says he was able to walk off the field with assistance, but walking exacerbated his pain. On physical exam, the ankle appears swollen. There is anterior displacement of the talus from the tibia. He has an antalgic gait and requires rest after walking 15 steps. He is advised to rest, ice, compress, and elevate the ankle for the next 2-3 days. Introduction Clinical definition ankle ligament injury (e.g., stretching and partial or complete rupture) Epidemiology Incidence a common injury seen by primary care physicians ETIOLOGY Pathoanatomy the ligaments of the ankle provide mechanical stability proprioceptive information joint motion lateral ankle sprain inversion of a plantar-flexed foot injures the ankle's lateral ligament complex medial ankle sprain forced ankle eversion injures the ankle's medial deltoid ligament complex syndesmotic sprain syndesmotic structures become injured with forced dorsiflexion and/or eversion login to view 5 more bullets Presentation Symptoms pain swelling muscle spasms Physical exam tenderness to palpation anterior drawer test assesses for anterior displacement of the talus on the tibia login to view 1 more bullet talar tilt test assesses the integrity of the calcaneofibular ligament Imaging Radiography indication depend on the Ottawa ankle rules login to view 4 more bullets Differential Fracture differentiating factor the appearance of a fracture on imaging patients who are unable to bear weight on the foot DIAGNOSIS Making the diagnosis a clinical diagnosis that can be supported by injury Treatment Conservative RICE (Rest, Ice, Compression, and Elevation) therapy indication login to view 1 more bullet physical therapy indication login to view 1 more bullet Operative ligament repair indication login to view 1 more bullet Complications Prolonged pain Ankle stiffness and instability Recurrent ankle sprain Prognosis Usually excellent