Ultasound guided management of ankle sprain

Mattam Sanjay, Babulreddy Bommireddy, Matapathi Umamahesh


Background: Ankle sprain accounts for 15-20% of sports injuries. They are complex injuries and studies that better delineate the etiology are needed. The accuracy of ultrasound as a diagnostic modality of ankle sprain is comparable to MRI.  In this study we evaluated the use of ultrasound in delineating the grade of sprain, with special emphasis of grade 2 sprains.

Methods: We prospectively studied 80 ankle sprains of over two years. All the patients with features of ankle sprain were evaluated with high frequency ultrasound. Grade 1 & 2 sprains were included in the study. All the patients were followed up for 1 year. Grade 2 sprains were treated with cast for 6 weeks and evaluated for any residual symptoms and chronicity.

Results: There were 51 males and 29 females with right ankle injured in 57 patients. Seventy-three patients were injured during their leisure activities and 7 were sports injuries. According to ultrasound grading, there were 58 grade 1 injuries, 22 being grade 2 sprain. All the patients were followed up till 1 year. At the end of one year, 79 patients were recovered well with no residual symptoms.

Conclusions: Ultrasonogram effectively differentiates grade 1 from grade 2 and gives a clue for further management. Therefore, we recommend routine use of ultrasonogram for every ankle sprain. For grade 2 sprains, rigid immobilization for 6 weeks gives excellent results with no residual symptoms.


Lateral ankle sprain, Sprained ankle syndrome, Ultrasonogram

Full Text:



Barker HB, Beynnon BD, Renstron PA. Ankle injury risk factors in sports. Sports Med. 1997;23:69-74.

Bennet WF. Lateral ankle sprains. – 1994;23:504 –10.

Sanjay M, Pandurangarao KRP. Non operative of chronic ankle sprain. International J Res Medical Sci. 2015;3(3):635-9.

Fallat I, Grimm DJ, Saraccoja. Sprained ankle syndrome prevalence and analysis. J foot ankle surg. 1998;37:280-5.

Milgrom C, Shlamkovitch N, Finestone A, Eldad A, Laor A, Danon YL, et al. Risk factors for lateral ankle sprain: a prospective study among military recruits. Foot Ankle. 1991;12(1):26-30.

Verhagan RA, Keizer G, Vandijik CN. Inversion trauma of ankle. Arch Ortho Trauma Surg. 1995;14: 92-6.

Milz P, Milz S, Steinborn M, Mittlmeier T, Putz R, Reiser M. Lateral ankle ligaments and tibio-fibular syndesmosis.13 MHZ high frequency sonography and MRI compared in 20 patients. Acta orthop scand. 1998;69:51-5.

Sung KS, Park JM. Acute ankle sprains. Arth Orthop Sports Med. 2016;3(1):11-7.

Balduini FC, Tetzlaff J. Historical perspectives on injuries of ligaments of ankle. Clin Sports Med. 1982;1:3-12.

Houglum PA. Soft tissue healing and its impact on rehabilitation. J Sport Rehabilitation. 1992;1:19-23.

Bachmann LM, Kolb E, Koller MT, Steurer J, Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.

Bosien WR, Sherwin O, Rusell SW. Residual disability following acute ankle injuries. J Bone Jont Surg Am. 1955;37(6):1237-43.

Eils E, Demming C, Kollmeier G, Lotharthorswesten, Volker K, Rosenbaum D. Comprehensive testing of 10 different ankle braces:evaluation of passive and rapidly induced stability in subjects with chronic ankle instability. Clin Biomech. 2002;17:526-35.

Yeungm MS, Kai- Mingchanmch, Som CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Spo Med. 1994;28(2) :112-6.

Glasgow M, Jakson A, Angus M, Jameson. Instabilities of ankle after injury to the lateral ligament. JBJS Br. 1980; 62(2):196-200.

Alanen V, Simotaimela, Jaakokinnunen, Seppo K, Koskinen, Erkkikaraharju. Incidence and clinical significance of bone bruises after inversion supination of ankle injury. JBJS Br. 1998;80(3):513- 5.

Ferran NA, Maffulli N. Epidemiology of sprains of lateral ligament complex. Foot Ankle Clin. 2006;11:659-62.

Cheung Y, Rosenberg ZS. MR imaging of ligamentous abnormalities of the ankle and foot. Mag Reson Imaging Clin N Am. 2001;9:507-31.

Miner Hayood T. Magnetic resonance imaging of the musculoskeletal system, Part 7. The ankle. Clin Orthop Relat Res. 1997;336:318–36.

Striepling E, Behrens P, Doniec JM, Havemann D. Ultrasonic assesment to the ankle joint in supination trauma. Aktuelle Traumatol. 1991;21:194–6.

Rawool NK, Nazarian LN. Ultrasound of the ankle and foot. Semin Ultrasound CT MR. 2000;21:275–84.

Morvan G, Busson J, Wybier M, Mathieu P. Ultrasound of the ankle. Eur J Ultrasound. 2001;14:73–82.