A Typical But Atypical Ankle Inversion Injury - Page #1

Author: Christa (Cheyenne) Goodwin, DO
Co Author #1: Margaret E. Gibson, MD
Senior Editor: Joseph Chorley, MD
Editor: Natalie Stork, MD

Patient Presentation:
A previously healthy 13 year-old female presented to the sports medicine clinic with left ankle pain and swelling following an acute left ankle injury.

The patient was playing in a basketball game when she inverted her left ankle. She felt an immediate pop and pain. She was unable to walk or bear weight through the left lower extremity. She was initially evaluated in urgent care and x-rays were obtained. X-rays demonstrated a subtle lucency over the lateral aspect of the distal tibial metaphysis and epiphysis Case Photo #1 Case Photo #2 . She was diagnosed with a Salter Harris II fracture of the distal tibia and placed in a CAM boot and instructed to remain non-weight bearing. She presented to the sports medicine clinic 1 week later and continued to report lateral ankle pain and swelling. The patient was in a considerable amount of pain. There had been no improvement in the patientís pain or swelling. She was still unable to bear weight through the left ankle and did not report any mechanical symptoms. She denied any prior injuries to the left ankle.

Physical Exam:
BMI: 19.8
Focused exam of LEFT Lower Leg
Inspection: There was bruising over the lateral and medial malleolus
Palpation: There was no tenderness to palpation of proximal tibia or fibula. The patient had focal tenderness to palpation over the distal tibia and fibula.
Range of motion: The patient demonstrated limited range of motion due to soft tissue swelling and pain. She was unable to actively dorsiflex, plantarflex, invert or evert her ankle without severe pain. The patient was able to wiggle toes.
Strength: Due to pain, she demonstrated limited effort with strength on the left lower extremity
Neuro: Sensation was intact to light touch

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