Unusual Weakness After Ankle Sprain In High School Athlete - Page #1

Author: Steven Albrechta, MD
Co Author #1: Clinton Hartz, MD
Editor: David Webner, MD, FAMSSM

Patient Presentation:
A 16-year-old male high school football player presented 2 weeks after a left inversion ankle sprain after being tackled during a game. He complained of numbness along the dorsum of his left foot, and pain that had worsened since the injury. He had been using an AFO walking boot, but the pain continued. He noted worsening of the numbness especially with prolonged walking. He reported aching and burning pain (worse at night) as well as a resolving bruise along the lateral ankle/foot. He was unable to lift his great toe and experienced numbness there too. When he scratched his lateral leg, he experienced foot numbness and tingling.

Healthy high school athlete. Few ankle sprains in the past but had no lingering pain

Physical Exam:
General: Healthy appearing 16-year-old male in no distress.
Musculoskeletal: Left lower extremity showed no bruising, no atrophy and only mild swelling over anterior lateral ankle. With palpation, there was tenderness over peroneal muscle belly & tendons, and over the anterior talofibular ligament. No crepitus with movement; skin turgor was normal. Range of motion of his ankle showed 0 degrees of dorsiflexion and 30 degrees of plantar flexion. There was 4+/5 strength with plantar flexion, dorsiflexion and eversion. There was 5-/5 strength with inversion. Anterior drawer and Thompsonís test were negative. On exam of his left great toe, he was unable to extend the toe but had full flexion.
Neurovascular: Pulses were present, normal and symmetric. He had decreased sensation to light touch. Slightly positive Tinelís sign over common peroneal nerve.

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