Ankle injuries account for up to 40% of all sports injuries and are often seen in the physiotherapy clinic. Many have long-term residual symptoms, and up to 20% develop chronic instability. Samantha Nupen explores good clinical practice to ensure a comprehensive assessment to guide management.
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When a patient with an ankle injury hops or hobbles into the rooms, the first clinical decision to make is whether to send them for an x-ray. The severity of the swelling and bruising rarely corresponds to the severity of the injury. The Ottawa Ankle Rules (OAR) are reliable to help make this decision(1).
Clinicians can use anteroposterior and lateral views to exclude lateral malleolus or distal fibula fractures, the most common ankle fracture.
Fractures of the base of the fifth metatarsal are commonly associated with severe ankle sprains. Avulsion fractures account for 93% of these, with Jones fractures less common but important not to miss because they take longer to heal due to poor circulation (see figure 1).
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