Ankle Injuries: When an Ankle Sprain is Not a True Ankle Sprain

It’s happened to all of us. You’re out for a walk or playing basketball with your friends, and you step on an uneven surface – suddenly you feel a sharp pain in your ankle. You’ve just suffered an ankle sprain. Or have you? In this blog post, we will explore the different types of foot and ankle injuries that can occur. If you’ve been experiencing pain in your outer foot and/or ankle, it’s important to seek medical attention to determine the cause of the pain and get the proper treatment.

What is an ankle sprain?

An ankle sprain is an injury to the ligaments that support the ankle joint. The most common ligament that is injured is called the anterior talofibular ligament, or ATFL for short. Two other ligaments support the ankle and can also be injured with a lateral ankle sprain. These are the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). A classic ankle sprain injury will involve damage to at least one of these ligaments.

How do you know if you’ve sprained your ankle, or if it’s something else entirely?

Injuries to the different ligaments, bones, and tendons to the outer ankle can produce similar symptoms immediately after the injury. As such, this can make it challenging to differentiate between one injury and another, at least initially. At the end of the day, the exact injury doesn’t matter from a treatment standpoint, unless there is an obvious fracture or dislocation, because in most cases a period of immobilization, rest, compression, ice, and pain medications will be recommended to allow the acute symptoms to subside.

One common misconception we hear all the time from patients is that they didn’t think their foot or ankle bone was fractured or broken because they were able to walk on it, or because it wasn’t especially painful, or the pain decreased in intensity quite quickly. It is sometimes possible to walk on these injuries despite having a significant fracture, so do not let this be a reason to not seek medical attention.

Rarer injuries that can occur with the same mechanism of injury that occurs during an ankle sprain are sometimes missed by emergency rooms, urgent care facilities, and even radiologists. An expert foot and ankle specialist examination is the way to go after this injury, especially if symptoms are persisting despite good recovery measures.

What are some of the other causes of foot and ankle pain after a sprain?

If someone has an understanding of the basic anatomy of the outer part of the ankle and foot, they understand that almost every structure can be injured with the same mechanism of injury that occurs with an outer/lateral ankle sprain.

Cervical ligament sprain/tear

The cervical ligament is a ligament that exists outside the ankle joint. It is located between the heel bone, and the bone above it called the talus.

Bifurcate ligament sprain/tear

This is another ligament on the outer part of the foot that has 2 parts. Both parts originate from the front part of the heel bone, called the calcaneus. The first per the ligaments projects forward and attaches to a bone in the hindfoot called the cuboid. The other part of the ligament projects in the inner direction and connects to a bone called the navicular bone.

Heel bone/calcaneal anterior process fracture

This is a small fracture that can occur to the front-most part of the heel bone.

Superior peroneal retinaculum tear/rupture

This is a ligament that anchors the peroneal tendons tight within their sheath behind the outer ankle bone of the fibula.

Peroneal tendon tear/rupture

Peroneal tendons are 2 tendons present on the outer part of the ankle that can be injured with an outer/lateral ankle sprain.

When should you see a doctor about your ankle injury, and what will they do to diagnose it properly?

If you have injured your ankle, it is always best to see a doctor. They will be able to properly diagnose your injury and give you the correct treatment plan. Depending on the severity of your injury, you may need to get a CT scan or an MRI. These imaging tests will help the doctor determine if you have any ligament or tendon damage.

As you can see above, multiple obscure injuries can occur with a lateral ankle sprain and it takes an astute practitioner to be able to pinpoint the site of injury and thus provide an appropriate rehabilitation program.