M. Gómez de Pablos Romero*, M. Sánchez Martín**
*Residente de Pediatría del Hospital Universitario de Móstoles. **Residente de Pediatría del Hospital Universitario La Paz.
22. Ankle sprain in the ED
Resident: Good evening, how can I help you?
Mother: Good evening Doctor. Carol’s already 13 years old, so she can tell you what has happened to her.
Resident: Very good, Carol. What’s wrong?
Carol:Hello Doctor. I twisted my right ankle in an awkward way this afternoon while I was playing football and the pain has worsened even though I’ve taken ibuprofen.
Resident: Can you walk properly? Is it the first time this happens to you?
Carol: I can walk although it hurts. It has never happened to me before.
Resident: Before I take a look at your ankle, tell me, do you have any other medical records?
Mother: No, she is a healthy girl.
Resident: OK, let’s take a look at your ankle. Please take off both your shoes and socks.
Inspection: Swelling of the region anterior to the lateral malleolus and proximal to the ankle joint, no ecchymosis. Palpation: Tenderness of the swollen region. Pain to palpation of the tip of the lateral malleolus. No pain to palpation of the rest of the fibula, tibia, base of the fifth metatarsal, navicular bone, talocrural joint line or Achilles tendon. Pain on forced passive inversion of the ankle, not on eversion. Able to bear weight and walk with a slight limp.
Resident: Carol, it looks as if you have an ankle sprain. Nevertheless, we need to discard bone fracture with an X-ray.
30 minutes later…
Resident: Carol, I have good news, the radiograph is normal. Therefore, you have a lateral ankle sprain. Ankle sprains are frequent. The most common mechanism of ankle injury is inversion of the foot, which causes damage to the lateral ligament complex of the ankle, especially to the anterior talofibular ligament. It seems like this is your case.
Carol: Does it mean I need a plaster? Will I have to use crutches?
Resident: No, compression with an elastic bandage will be sufficient, although you have to rest for 3 to 5 days. Elevating the ankle and applying ice for 15 minutes every 3-4 hours for the first 2 days will improve the swelling. You can take ibuprofen 3 times a day to control the pain. As for the crutches, it’s up to you, you can use them if they help you walk. However, you shouldn’t walk long distances the first days.
Carol: So how long will it be until I can play football again?
Resident: Begin with light ankle exercises like plantar flexion, dorsiflexion, and foot circles when the pain and swelling are over. Then, when you feel confident you can go back to playing football and other sports.
Mother and Carol: Thank you very much.
Resident:Take care. If you don’t get better in 3-4 days, come back.
Ankle sprain: esguince de tobillo.
Twisted (to twist): torcer, torcerse.
Awkward way: manera/forma rara.
Worsened (to worsen): empeorar.
Hurts (to hurt): doler.
Medical records: antecedentes médicos.
Able to bear weight: capaz de soportar peso.
X-ray: rayos-X, radiografía.
(To) rest: reposar.
(To) improve: mejorar.
Light (ankle) exercises: ejercicios suaves (de tobillo).