I routinely see patients after continued pain after a simple ankle sprain. They will present usually after 8 weeks of conservative treatment with continued pain.
Several areas need to be addressed:
Talar dome lesions. This is an injury to the ankle mortise area that can sometimes only be diagnosed with an MRI.
Fracture os Trigonum. This is usually associated with posterior ankle pain and can be easily diagnosed via plain film radiographs. We often perform diagnostic local injection to aid in diagnosing this injury. MRI is also a useful tool in diagnosis and treatment.
Fifth metatarsal fracture. The mechanism of inversion can cause two types of fractures. The first being a simple avulsion injury via the peroneal longus. This trauma is usually not an issue 6-8 weeks after conservative ankle sprain treatment. The second being a Jone’s fracture. This is a more significant injury usually requiring surgical intervention at 6-8 weeks after the injury.
Peroneal tendon injury. The bodies response to an inversion injury ( Common ankle sprain) is a firing of the lateral ankle musculature. The bodies response to the inversion injury can be so strong that it injures the tendon. This usually requires an MRI and surgical repair.
These are the most commonly missed injuries following an ankle sprain that is not responding to conservative therapy.
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