Ankle/Foot Pathologies = Ligament Sprains

early, 1 minute, open, closed, 1 minute, touches, recurrence, frequently

Clinical Tests for Ankle Sprain = SL Balance Functional Test: • Most common ____________ assessment • Maintain balance on single limb x ____________ (eyes ____________) • Eyes ____________ assessment for lower grade sprain • Measurement: Time (for ____________) or number of ____________, or both, to determine risk of ____________ • Reassess ____________

anterior drawer stress, anterior lateral drawer

Clinical Tests for Ankle Sprain = Special Tests for ATFL: - ____________ test - ____________ test

deltoid ligament, tibialis posterior

Syndesmosis Sprain = Collateral Damage: • ____________ • ____________

anterior talofibular, calcaneofibular, posterior talofibular

3 lateral ankle ligaments which can be injured due to inversion in PF or DF?

inversion, inversion, lateral

Ankle Sprains: - Most common = ____________ sprain (caused by excessive ____________ & injury to ____________ supporting ligaments)

athletic, sex, laxity, foot, height, weight, limb, laxity, alignment, strength, reaction time, postural sway

Ankle Sprains: - Most common ____________ injury - ____________, general joint ____________, and anatomical ____________ type are not risks for medial ankle sprain - ____________, ____________, ____________ dominance, ankle ____________, anatomical ____________, muscle ____________, muscle ____________, and ____________ are controversial as risk factors for lateral ankle sprain

3-34, 2 weeks, 96 months, high, activity, lifestyle, activity, strengthening, proprioceptive balance

Ankle Sprains: - Re-injury rate = ___-___% - Time frame = ____________ to ____________ - Re-injury most likely in ____________-risk sports/activities - Pt education based on ____________ and ____________; education to maintain ____________ level with ____________ ankle and ____________ exercises

sport, 49, basketball, soccer, volleyball, football, court, starts/stops, cutting

Ankle Sprains: - Risk of ankle injuries vary by ____________ (___% of ankle sprains due to athletics) - ____________ 41% - ____________ 8% - ____________ 25% - ____________ 9-10% - ____________ sports at a higher risk than general population - Any sport that involves quick ____________/____________ and ____________

non-operatively, lower, higher

Ankle Sprains: - Usually treated ____________ - ____________ grade sprain may not present to PT clinic - Usually see ____________ grade sprains in PT

symptoms, ROM, PRICE, NSAIDs, 3-5, elastic dressing, crutches, ROM, swelling, irritability, imaging

Ankle Syndesmosis Evaluation = Suspected Injury: - Is examination restricted due to ____________ or ____________ deficits? - With restrictions, rest via ____________ and ____________ for ___-___ days; consider use of ____________ or ____________ if necessary - With no restrictions, progressively increase ____________ as ____________ and ____________ decrease - With a positive syndesmosis test, ____________ indicated

difficult, time, acute ankle, imaging

Ankle Syndesmosis Evaluation: - Injuries of the syndesmosis are among the most ____________ to treat. - More ____________ is required for return to activity. - In the clinic, if the syndesmosis tests are positive in a patient with ____________ sprain, referral to the physician for ____________ is indicated.

weightbearing, immobilization, severity, SINSS

Bracing for Ankle Sprains: - External supports advised to encourage early return to ____________ - Severe injuries: Semi-rigid brace for ____________ - Consider injury ____________ and ____________

supports, tape, ACE wrap, quicker, instability, swelling, preferences

Bracing for Ankle Sprains: - Lace-up or semirigid ____________ (Aircast) more effective than ____________ or ____________ - When compared to ACE wrap, semirigid ankle support resulted in ____________ return to sports and work and less ankle ____________. - The lace-up ankle support significantly decreased persistent ____________ at short-term f/u compared with the semi rigid ankle support, taping, or ACE wrap - Consider patient's ____________

instability, motion, neuromuscular, sensorimotor

Chronic Ankle Instability (Recurrent Ankle Sprain) = Functional Instability: - Patients report feeling of ____________; however, joint ____________ tests normal - Hypotheses = ____________ or ____________ deficits

motion, ligament, PAMs, strength, peroneals, balance, functional, neuromuscular control

Chronic Ankle Instability (Recurrent Ankle Sprain) = Mechanical Instability: - Excessive joint ____________, assessed via ____________ tests and ____________ - Loss of ____________ in ____________ - Impaired ____________, assessed via ____________ tests to assess ____________

recurrent, years, mechanical, functional

Chronic Ankle Instability (Recurrent Ankle Sprain): - Multiple ____________ sprains over several ____________ - ____________ instability - ____________ instability

AROM, PROM, goniometer, bubble inclinometer, weightbearing, irritability

Clinical Tests for Ankle Sprain = Ankle ROM: - Assess both ____________ and ____________ - ____________ for primary motions (DF, PF, inv, ev) - ____________ for ____________ dorsiflexion (for individuals with lower ____________)

single-limb, star excursion balance

Clinical Tests for Ankle Sprain = Functional Tests: - ____________ balance - ____________ test

all, inversion/eversion, eversion

Clinical Tests for Ankle Sprain = Muscle Strength: - ____________ motions - Particular attention to ____________/____________ strength - Pain with ____________ suggests fibularis tendon involvement

instability, sprain, control, coordination, anterior, posteromedial, anterior, 4cm, 2.5, interventions

Clinical Tests for Ankle Sprain = SEBT Functional Test: • Patients with ankle ____________ or after ____________ display decreased reach compared to uninvolved; assess ____________ and ____________ • ____________ and ____________ reach distance deficits on involved side predictive of ankle instability • Individuals with ____________ reach side to side difference >_____ = ___ times more likely to sustain LE injury • Components of tests can be used as ____________

anterior drawer, talar tilt, 60-70, anterior drawer, talar tilt, 10, anterior drawer, talar tilt, 20

Clinical Tests for Ankle Sprain = Special Test Interpretations: - ____________ positive & ____________ negative = Most likely isolated ATFL injury (___-___% of all inversion injuries) - ____________ negative & ____________ positive = Most likely CFL injury (___% of all inversion injuries) - Both the ____________ & ____________ positive = Most likely ATFL/CFL injury (accounts for ___% of inversion injuries)

medial talar tilt, anterior drawer, anterior lateral drawer

Clinical Tests for Ankle Sprain = Special Tests for CFL: - ____________ test (primary) - ____________ & ____________ tests

gait, swelling, assistive device, dynamic functional, swelling, figure 8, ROM, strength, special

Clinical Tests for Ankle Sprain: - Observation = ____________, ____________, ____________ - ____________ tests - ____________ assessment = ____________ girth - Ankle ____________ - Muscle ____________ - ____________ tests

lateral talar tilt, Kleiger rotation, deltoid ligament, syndesmosis

Deltoid Ligament Tests: - ____________ test - ____________ test - Differentiate ____________ from ____________ sprain

Ottawa ankle, tendon, burning, tingling, numbness, peroneal, medial joint impingement

Examination of the patient with lateral ankle sprain should screen for other potential injuries: • ____________ rules will help screen for fractures • Resisted tests will reveal any ____________ strain/rupture • Careful subjective and objective testing (____________, ____________, ____________) will screen for ____________ nerve stretch injuries • Joint testing will screen for ____________

pain, mobility, gait, mobility, movement, strengthening, proprioceptive,

General Treatment Principles following ankle sprains: - Crutches until walking is mostly ____________-free to encourage early ____________ and decrease ____________ deviations - Manual therapy when necessary to restore normal joint ____________ and facilitate ____________ - Progress ____________ and ____________ training to improve activity limitations and participation restrictions

2-3, crutches, pain, pumps/circles, calf, isometrics, manual, strengthening, proprioceptive, functional

General Treatment Principles following ankle sprains: - RICE ___-___x/day - ____________ - ____________-free ROM via ankle ____________/____________ - Gentle ____________ stretching/flexibility with towel/strap - ____________ to start tissue loading - ____________ therapy - ____________ and ____________ training - Progress to ____________ training

hemorrhage, swelling, 0.5, anterior drawer, medial talar tilt, motion

Grade 1 Inversion Sprain = Clinical Signs: - No ____________ - Min ____________ (___cm or less) - Negative ____________ - Negative ____________ - May have some ankle ____________ loss (minimal)

limp, functional, hopping, athletic, 8 days

Grade 1 Inversion Sprain = Functional Changes: - No or little ____________ - Min ____________ loss - Difficulty ____________ (____________ populations) - Recovery ____________

stretch, pop, instability, ligament, ATFL

Grade 1 Inversion Sprain = Pathology: - Mild ____________ (may hear a ____________) - No ____________ - Single ____________ (usually ____________)

hemorrhage, swelling, 0.5-2, anterior drawer, medial talar tilt, motion, balance/proprioception, weakness

Grade 2 Inversion Sprain = Clinical Signs: - Some ____________ - Localized ____________ (___-___cm) - Positive ____________ - Negative ____________ - Ankle joint ____________ loss - ____________/____________ changes - Muscle ____________

function, limp, toe raise, hop, run, 20, 10-30

Grade 2 Inversion Sprain = Functional Changes: - Some loss of ____________ reported - ____________ - Unable to ____________ - Unable to ____________ OR ____________ - Recovery ___ (___-___) days

popping, tearing, swelling/bruising, instability, ATFL, ATFL, CFL

Grade 2 Inversion Sprain = Pathology: - Tissue injury with feeling of ____________ or ____________ - More pronounced ____________/____________ - Mild to moderate ____________ - Complete tearing of ____________ or partial tearing of ____________ + ____________

hemorrhage, swelling, 2, Achilles tendon, medially, laterally, anterior drawer, anterolateral drawer, medial tilt, motion

Grade 3 Inversion Sprain = Clinical Signs: - Early ____________ - Diffuse ____________ >___cm, both sides ____________ - Possible tenderness ____________ and ____________ - Positive ____________ & ____________ - Positive ____________ test - Notable ankle ____________ loss

FWB, Ottawa ankle, pain, ROM, 40, 30-90

Grade 3 Inversion Sprain = Functional Changes: - Unable to ____________ (consider ____________ rules) - Significant ____________ inhibition - Initially almost complete loss ____________ - Recovery ___ (___-___) days

instability, popping, tearing, anterior capsule, ATFL, CFL

Grade 3 Inversion Sprain = Pathology: - Significant ____________ (Injury: Feeling of ____________ or ____________) - Complete tearing of ____________ - Complete tearing of ____________ - Complete tear of ____________

plantarflexed, inversion, inversion, plantarflexed, cutting

Inversion Ankle Ligament Sprain = Mechanism of Injury: - Foot ____________ with ____________ most commonly injures ATFL, followed by CFL - Foot planted with ____________ (not ____________) most commonly injures CFL (due to ____________ in soccer and field sports)

landing, landing, foot, curb, cutting, uneven, turn

Inversion Ankle Ligament Sprain = Mechanisms of Injury: • ____________ after rebound in basketball (especially if ____________ on another person's ____________) • Step off ____________ • ____________ sports • ____________ surfaces (lawn or field) • ____________ ankle when walking on sidewalk edge or in high heels

lateral, fibularis, fibular

Inversion Ankle Ligament Sprain: - ____________ ligaments most commonly sprained - Injury of ____________ muscles can occur - ____________ nerve

deltoid ligament, syndesmosis, dorsiflexion, dorsiflexion, tibia, fibula, dorsiflexion, external rotation

Kleiger Rotation Test: • Stresses the ____________ and also the ____________. • By placing the ankle in ____________, the syndesmosis is maximally stressed • End range ____________ causes separation of the ____________ and ____________ (as the wide anterior portion of the talar head rotates back into the mortise, it causes the tib/fib joint to spread) • Test syndesmosis by taking the ankle into full ____________, then adding ____________

inversion, plantarflexion, inversion, dorsiflexion, posterior, rotatory, talus

Lateral Ankle Ligaments: - Anterior talofibular ligament (ATFL) resists ____________ in ____________ - Calcaneofibular (CFL) resists ____________ in neutral or ____________ - Posterior talofibular ligament (PTFL) resists ____________ and ____________ subluxation of the ____________

star excursion balance, lateral, figure 8, 6-meter crossover

Lateral Ankle Sprain = Physical Performance Measures: • ____________ Test • ____________ hop for distance • ____________ hop • ____________ hop

global function, SF-36PF, ambulation, weightbearing, athletic

Lateral Ankle Sprain = RTS: - Prognostic factors for determining time to return to play were measures of ____________, ____________, athlete's ____________ status, ____________ activity scores, and self-reported ____________ ability.

1-10, 2-4, 5-8

Lateral Ankle Sprain = Typical RTS Time: • Grade 1: ___-___ Days • Grade 2: ___-___ Weeks • Grade 3: ___-___ Weeks

functional, compression stockings, anteroposterior, hyaluronic acid, jump stretch flex band, diclofenac, NSAID

Lateral Ankle Sprains = RTS: - Treatments that resulted in a shorter time to return to play, included: ____________ treatment, ____________, ____________ joint mobilization, ____________ injection, ____________ program, and ____________ (____________).

peroneal, medial, cuboid, cuboid 5th metatarsal ligament, peroneal, fracture, medial, palpation

Lateral Sprain = Collateral Damage: • ____________ tendons • Impingement of ____________ side • ____________ & ____________ • ____________ nerve • ____________ • Can result in some ____________ issues • ____________ tenderness

ATFL, CFL, PTFL, inversion, plantarflexion, dorsiflexion, high heels, curb, cutting, snowboarding

Lateral Sprain = Ligaments & Mechanism of Injury: • Ligs = ____________, ____________, ____________ • ____________ (Often in ____________, but may be ____________) • ____________, stepping off ____________, ____________ sports, ____________

anterior drawer, anterior lateral drawer, talar tilt

Lateral Sprain = Special Tests: • ____________ • ____________ • ____________

deltoid ligament, external rotation, dorsiflexion

Lateral Talar Tilt Test: • Test ____________ by performing ____________ in slightly less than full ____________

medial, lateral, type, mechanism, pain, medially, lateral, medial, lateral, laxity, medial, lateral

Lateral vs Medial vs Syndesmosis Ankle Sprain: • It is easy to differentiate between ____________ and ____________ ankle sprains by injury ____________ (though the patient doesn't always remember the exact ____________), and by area of ____________. • But recall that a lateral sprain causes compression ____________, so pain is not always isolated to the ____________ side of the ankle (Visa versa for medial ankle sprain). • Special tests easily differentiate ____________ and ____________ ligament ____________. • Syndesmosis injury can occur concomitantly in the ____________ ankle sprain (more common) but can also occur with a ____________ ankle sprain.

medial, delta, deltoid, stronger, foot/ankle, stability, shape, stability, inferiorly

Medial Ankle Ligaments: - Ligaments on the ____________ side of the ankle shaped like the Greek letter "____________" - The ____________ ligament is less often sprained; it is ____________ than ligs on the lateral side, and the architecture of the ____________/____________ provides more ____________ to prevent medial ankle sprain due to ____________ and ____________ of arches, and the extension of the lateral malleolus being more ____________ than the medial malleolus.

anterior tibiotalar, tibiocalcaneal, posterior tibiotalar, tibionavicular

Medial Ankle Ligaments: - ____________ - ____________ - ____________ - ____________

avulsion, medial malleolus, eversion, bimalleolar, Pott's, talus/ankle mortise, mobility

Medial Eversion Sprain = Concomitant Damage: - ____________ fracture of ____________ with ____________ - ____________ (____________) fracture due to CKC movements - ____________/____________ chondral lesions due to increased ____________ in the ankle

severity, longer, male, competition, medial ankle, syndesmosis, high ankle, male, female

Medial Eversion Sprain: - Due to ____________ of injury, it may take ____________ to heal - ____________ sex and higher level of ____________ are risk factors for ____________ and ____________ (____________) sprain - No real difference between ____________ and ____________ risk for syndesmosis sprain

eversion, medial, foot, 10, 75, fractures, concomitant

Medial Eversion Sprain: - The medial ankle ligaments are usually sprained by an ____________ motion, and/or a ____________ rotation of the leg over the fixed ____________. - ___% of ankle sprains - ___% of ankle ____________ occur on medial side - Associated ____________ damage

medial malleolus, lateral, tibialis posterior, tibialis anterior, lateral

Medial Sprain = Collateral Damage: • ____________ fracture • ____________ impingement • ____________ tendon • ____________ tendons • Can result in some ____________ damage

deltoid, eversion, plantarflexion, dorsiflexion, fixed foot

Medial Sprain = Ligaments & Mechanism of Injury: • Ligs = ____________ • ____________ (____________, ____________) • Rotate over ____________

talar tilt, Kleiger, external rotation

Medial Sprain = Special Tests: • ____________ test • ____________ (____________) test

chronic recurring

Potential Lateral Ankle Sprain Sequelae = Chondral Lesions: - ____________ episodes of inversion sprains

gliding, talus, medial malleolus, not

Potential Lateral Ankle Sprain Sequelae = Medial "Push-off" Fracture: - ____________ of the ____________ may create a fracture on the ____________ - ____________ very common

laxity, medial structures, joint mobility

Potential Lateral Ankle Sprain Sequelae = Medial Impingement: - Potential joint ____________ - Pinching of ____________ - Assessed with ____________ tests

feet, burning, tingling, months, swelling, numbness/burning

Potential Lateral Ankle Sprain Sequelae = Superficial Peroneal Nerve: - Sensory changes over ____________ - "____________ and/or ____________" several ____________ post-injury accompanied by increased ____________ - Residual ____________/____________ may be due to nerve

medial joint capsule/ligaments, peroneal tendon, medial malleolar, avulsion, 5th metatarsal, lateral malleolus, chondral, superficial, peroneal

Potential Lateral Ankle Sprain Sequelae: - Impingement of ____________/____________ - ____________ strain/rupture - ____________ "push-off" fracture - ____________ fracture of ____________ or ____________ (fairly common) - Talus/ankle mortise ____________ lesions - ____________ branch of ____________ nerve injuries

medially, laterally, mortise, tibia, fibula, dorsiflexion, eversion, tibia, fibula

Rotational mechanism and syndesmosis sprain: - Tibia rotates ____________ on fixed foot - Talus rotates ____________ (relative to ____________ joint) spreading ____________ and ____________. - Combined with ____________ and/or ____________: Further spreads ____________ and ____________

pain, tibia, fibula, spreading, below, distal, distal

Squeeze Test (Syndesmosis): - Provokes ____________ in syndesmosis sprain - Squeeze the ____________ and ____________ together at various places above the ankle to create a "____________" apart ____________ the squeeze location - Pain in the region of the ____________ syndesmosis confirms ____________ syndesmotic injury

ATFL, PTFL, interosseous membrane, dorsiflexion, external rotation, jumping, landing

Syndesmosis Sprain = Ligaments & Mechanism of Injury: • Ligs = ____________, ____________, ____________ • Forced ____________, ____________ ankle/foot • ____________ and ____________

Kleiger, external rotation, squeeze

Syndesmosis Sprain = Special Tests: • ____________ (____________) test • ____________ test

squeeze, Kleiger rotation

Testing for Syndesmosis injury: - ____________ test - ____________ test

individual, demands, judgment

The return to activity will depend on the ____________, the ____________ of the activity, and the practioner's ____________.

dorsiflexion, external rotation, medial, fixed, hyperdorsiflexion, external rotation, eversion, dorsiflexion

Tibiofibular Syndesmosis (High Ankle Sprain) = Mechanism of Injury: • Forced ____________, ____________ ankle/foot (____________ rotation of the leg over the ____________ foot) • ____________ (football, skiing, snowboarding). • ____________ • ____________ of the Talus. Often combined with ____________ (spreads syndesmosis)

dorsiflexion, Kleiger, squeeze, tendons, deltoid ligament

Tibiofibular Syndesmosis (High Ankle Sprain) = Rehab & Healing Process: • During early rehab, control amount of ____________ • Positive ____________ test (Differentiate from deltoid ligs by location of the sx) • Positive ____________ test (squeeze tib and fib together) • Other structures that might be involved include the ____________ or ____________

1-11, dorsiflexion, eversion, torsion, longer, weightbearing, distal tibiofibular, ligament

Tibiofibular Syndesmosis (High Ankle Sprain): • ___-___% of ankle sprains • Mechanism of injury involves ____________ and ____________ (due to ____________ of the syndesmosis) • Takes ____________ to heal; with ____________, the ____________ joint spreads and ____________ is re-irritated.

ROM, movement, pain, control

Treatment for Ankle Sprains = Manual Therapy: - Increase ____________ and restore ____________ loss - Mitigate ____________ - Facilitate ____________ for activity

ROM, strengthening, neuromuscular, movement coordination, SLS, uneven surfaces, direction

Treatment for Ankle Sprains = TherEx: - Restore ____________ and ____________ through tissue - Progress to ____________ and ____________ re-training (____________, ____________, ____________)

weightbearing, manual, cryotherapy, ultrasound, laser, exercises, activities, sport

Treatment for Ankle Sprains: - Early ____________ with Support - ____________ Therapy - ____________ (rather than ____________ or ____________) - Therapeutic ____________ & ____________ - ____________-related activity per patient specific needs

mobilization, external support, PRICE, ROM, swelling, WBAT, neuromuscular, manual, functional, coordination, agility, sport-specific

Treatment of Ankle Sprains = Grades 1 & 2: - Key = early ____________ - Use of ____________ for stability - Encourage gentle ____________, ____________, ____________ management, and ____________ early - ____________ training - ____________ therapy - Progression to ____________ re-training for ____________, ____________, & ____________ training

SLS, SEBT, neuromuscular, education

Treatment of Grade 3 Ankle Sprains = Address instability during healing: - Functional tests = ____________, ____________ - ____________ re-training and patient ____________

72 hours, inflammation, ROM, crutches, WBAT, weightbearing

Treatment of Grade 3 Ankle Sprains = RICE & WB: - RICE for at least first ____________ to decrease ____________ and increase ____________ - PWB with ____________, progressing to ____________ when pain subsides; control ____________

Ottawa ankle, immediately, 5th metatarsal

Treatment of Grade 3 Ankle Sprains = Radiographs: - Many with grade 3 ankle sprain would alert you to apply ____________ rules, since many cannot bear weight ____________ after the injury. - Tenderness at the base of the ____________

chronic instability, injury recurrence, stabilize, laxity, instability, instability, recurrence

Treatment of Grade 3 Ankle Sprains = Sequelae: - May have ____________ with ____________ - Surgery may be warranted to ____________ ankle due to increased ____________ and ____________ - Address ____________ during healing to decrease risk of ____________

10 days, swelling, stabilization

Treatment of Grade 3 Ankle Sprains = Splint & Immobilizer: - Usually applied for ____________ - Control ____________ and promote ____________

rare, chronic ankle instability, large, laxity, instability

Treatment of Grade 3 Ankle Sprains = Surgery: - ____________ - Indicated for ____________ and/or ____________ grade 3 sprain - Surgery helps fix ____________ or ____________

radiographs, RICE, weightbearing, splint, immobilizer, isometrics, ROM, progressive resistive, balance

Treatment of Grade 3 Ankle Sprains: - Are ____________ indicated? - ____________ and ____________ considerations - ____________ or ____________ - Gentile ____________ can begin as soon as tolerated - ____________, ____________, and ____________ exercises once immobilization discontinued

prophylactic bracing, taping, sports, 2, inversion

Treatment of Grades 1&2 Ankle Sprains = External Support: - Some evidence for ____________ or ____________ to prevent injury after sprains, as people return to demanding ____________ - More common for grade ___ sprain management - Control ____________ motion while structures heal

dorsiflexion, impairments

Treatment of Grades 1&2 Ankle Sprains = Manual Therapy: - Address ____________ (commonly decreased after injury) - Address ____________

peroneal muscle, proprioceptive, function, re-injury, confidence, SLS, uneven surfaces, progression

Treatment of Grades 1&2 Ankle Sprains = Neuromuscular Training: - ____________ and ____________ training - Shown to improve ____________ and decrease ____________ - Increases patient's ____________ with ____________ and ____________ - ____________ as appropriate

immobilization, 2 weeks, weightbearing, CAM, rocker, progressive strengthening, neuromuscular, running, 2-6 weeks

Treatment of Stable Syndesmosis Injuries: - Brief ____________ (up to ____________) and protected ____________ (black ____________ boot with ____________ bottom) - Followed by ____________ exercise, ____________ training, and ____________ - Return to competition in ____________

evidence, consistent, surgery, stable

Treatment of Syndesmosis Injuries: - In athletics, we don't find an ____________ based or ____________ approach to treating the stable injury that does not require ____________ - Protocol for ____________ injuries

ATFL, slight, local, full, partial, stretched, none

West Point Ankle Sprain Grading System for Ankle Sprains = Grade 1: - Location of tenderness = ____________ - Edema/ecchymosis = ____________, ____________ - WB ability = ____________ or ____________ - Ligament damage = ____________ - Instability = ____________

ATFL, CFL, moderate, local, crutches, partial, none, slight

West Point Ankle Sprain Grading System for Ankle Sprains = Grade 2: - Location of tenderness = ____________, ____________ - Edema/ecchymosis = ____________, ____________ - WB ability = difficult without ____________ - Ligament damage = ____________ tear - Instability = ____________ or ____________

ATFL, CFL, PTFL, significant, diffuse, pain, complete, definite

West Point Ankle Sprain Grading System for Ankle Sprains = Grade 3: - Location of tenderness = ____________, ____________, ____________ - Edema/ecchymosis = ____________, ____________ - WB ability = impossible without significant ____________ - Ligament damage = ____________ tear - Instability = ____________