Ankle problems masquerading as sprains

A ligament is designed to function as a strong fibrous attachment between two bones and the joint that they form. The ligament permits normal functional range of motion while preventing abnormal motion of the respective joint. Injuries to the ligaments surrounding the ankle joint are extremely common and usually pose no significant diagnostic dilemma. Normally these injuries may be managed conservatively, with little work-up and with uncomplicated treatment. It is not uncommon, however, for a patient to present to his primary-care physician with complaints of continued ankle pain or instability. Many physicians have heard a patient state that he has "weak ankles," which continually cause some degree of problems. These represent the ankle injuries that are initially misdiagnosed as ankle sprains. This article will make the reader more aware of these misdiagnoses that masquerade as simple ankle sprains. It emphasizes why these injuries must be considered in the differential diagnosis of every acute ankle sprain and in "sprains" not improving as expected with routine management. Such injuries, if improperly diagnosed and treated, can either leave the patient with long-term disability or turn a relatively routine injury into one requiring surgical intervention. The most common entities that are discussed include talar dome fractures, fractures of the lateral process, posterior process of the talus fractures (lateral and medial tubercles), fracture of the anterior process of the calcaneus, and injury to the bifurcate ligament.