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Importance of Neurologic Exam in Ankle Sprains

Ankle sprains are fairly common, especially among athletes of all kinds. In this case report, a lateral ankle sprain (along the outside of the ankle) was accompanied by nerve damage. The patient was a 25-year-old professional dancer. The sural (sensory) nerve to the lower leg was affected.

Symptoms included numbness and tingling in the heel and along the lateral (outside edge) of the foot. There was pain and mild swelling around the lateral ankle bone. The patient could not put his full weight on that foot. He could not perform his regular dance activities.

Specific testing performed by the physician resulted in a diagnosis of lateral ankle sprain with sural nerve injury. Treatment was planned that took into consideration the added problem of a nerve injury. Anti-inflammatory medication and limited icing of the ankle were prescribed. The patient was also given a home-exercise program.

The dancer was able to return to full activity after one-month. He did not wear a brace right after the injury in order to avoid putting any pressure on the nerve. But an ankle brace was worn during dance performances for the first two weeks to prevent re-injury.

Nerve damage is uncommon in foot and ankle injuries among athletes. When they do occur, it's important that the physician makes a correct diagnosis. If clinical testing is not conclusive, then nerve conduction tests can be done to confirm the diagnosis.

The authors report a positive outcome and attribute it to a correct diagnosis and prompt, accurate treatment. Ice was limited to avoid thermal injury to the nerve. Taping and bracing weren't allowed to avoid compressing the nerve. Anti-inflammatory drugs and limited activity also helped the inflamed nerve calm down and heal without further aggravation.

Vijay Jotwani, MD, et al. Cutaneous Sural Nerve Injury After Lateral Ankle Sprain: A Case Report. In The Journal of Musculoskeletal Medicine. March 2008. vol. 25. No. 3. Pp. 126-128.

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