Ankle Sprain

  • Ferdinando Draghi


Acute sporting injuries to the ankle present a substantial portion of cases of sporting injuries; inversion injuries are the most common. Running, twisting, and turning activities present a continued risk of injury that might range from an ankle sprain to a career-threatening injury. Ankle sprains most often occur during inversion; the anterior talofibular ligament is the most frequently affected ligament, and the calcaneofibular is the second most affected (rupture of both ligaments is possible and occurs in about 20% of cases). Isolated lesions of the calcaneofibular ligament are rare but can occur. Involvement of the posterior talofibular ligament and of the anterior talotibial ligament is extremely rare. Sonography is diagnostic for the evaluation of acute ankle injuries.


  1. 1.
    Allison SJ, Nazarian LN. Musculoskeletal ultrasound: evaluation of ankle tendons and ligaments. AJR Am J Roentgenol. 2010;194:W514.CrossRefGoogle Scholar
  2. 2.
    Precerutti M, Bonardi M, Ferrozzi G, Draghi F. Sonographic anatomy of the ankle. J Ultrasound. 2013;17:79–87.CrossRefGoogle Scholar
  3. 3.
    Yıldız S, Yalcın B. The anterior talofibular and calcaneofibular ligaments: an anatomic study. Surg Radiol Anat. 2013;35:511–6.CrossRefGoogle Scholar
  4. 4.
    Peetrons P, Creteur V, Bacq C. Sonography of ankle ligaments. J Clin Ultrasound. 2004;32:491–9.CrossRefGoogle Scholar
  5. 5.
    Bianchi S, Martinoli C, Gaignot C, De Gautard R, Meyer JM. Ultrasound of the ankle: anatomy of the tendons, bursae, and ligaments. Semin Musculoskelet Radiol. 2005;9(3):243–59.CrossRefGoogle Scholar
  6. 6.
    Gursoy M, Dag F, Mete BD, Bulut T, Uluc ME. The anatomic variations of the posterior talofibular ligament associated with os trigonum and pathologies of related structures. Surg Radiol Anat. 2015;37(8):955–62.CrossRefGoogle Scholar
  7. 7.
    Draghi F, Gregoli B, Bortolotto C. Absence of elevation of fibular tendons during dorsal hyperflexion of the foot: a sign of loss of the calcaneofibular ligament. J Ultrasound Med. 2014;33(7):1307–8.CrossRefGoogle Scholar
  8. 8.
    Breitenseher MJ. Injury of the ankle joint ligaments [in German]. Radiologe. 2007;47:216–23.CrossRefGoogle Scholar
  9. 9.
    Milz P, Milz S, Steinborn M, Mittlmeier TH, Reiser M. 13-MHz high frequency ultrasound of the lateral ligaments of the ankle joint and the anterior tibia-fibular ligament: comparison and results of MRI in 64 patients [in German]. Radiologe. 1999;39:34–40.CrossRefGoogle Scholar
  10. 10.
    Muhle C, Frank LR, Rand T, et al. Collateral ligaments of the ankle: high resolution MR imaging with a local gradient coil and anatomic correlation in cadavers. Radiographics. 1999;19:673–83.CrossRefGoogle Scholar
  11. 11.
    Haraguchi N, Toga H, Shiba N, Kato F. Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. Am J Sports Med. 2007;35:1144–52.CrossRefGoogle Scholar
  12. 12.
    Yamaguchi S, Akagi R, Kimura S, Sadamasu A, Nakagawa R, Sato Y, Kamegaya M, Sasho T, Ohtori S. Avulsion fracture of the distal fibula is associated with recurrent sprain after ankle sprain in children. Knee Surg Sports Traumatol Arthrosc. 2018.
  13. 13.
    Stoppa D, Pagani C, Canepari E, Draghi F. Lesioni croniche del legamento peroneo-astragalico-anteriore dopo distorsione: correlazione clinico-ecografica Il giornale italiano di. Radiol Med. 2017;4:15–7.Google Scholar
  14. 14.
    Lapègue F, Faruch M, Brun C, Bakouche S, Chiavassa H, Sans N. Lésions du ligament collatéral latéral et de la syndesmose tibio-fibulaire inférieure en 10 points-clés, vol. 24. La cheville, Paris: Gel-Contact; 2015. p. 6–13.Google Scholar
  15. 15.
    Lapègue F, Sans N, Jacob D. Cheville et tarse. In: Sans N, Lapègue F, Jacob D, editors. Échographie musculosquelettique. 2nd ed. Paris: Elsevier Masson; 2014. p. 271–322.Google Scholar
  16. 16.
    Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S. Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol. 2011;18(3):211–25.CrossRefGoogle Scholar
  17. 17.
    Sangiovanni A, Colli Tibaldi E, Draghi F. HIV-related osteonecrosis of the ankles and feet. EURORAD. 2016.
  18. 18.
    Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015;35(1):179–99.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ferdinando Draghi
    • 1
  1. 1.Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly

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