Ankle stability and movement coordination impairments: ankle ligament sprains.

RISK FACTORS – ACUTE LATERAL ANKLE SPRAIN: Clinicians should recognize the increased risk of acute lateral ankle sprain in individuals who (1) have a history of a previous ankle sprain, (2) do not use an external support, (3) do not properly warm up with static stretching and dynamic movement before activity, (4) do not have normal ankle dorsiflex-ion range of motion, and (5) do not participate in a balance/ proprioceptive prevention program when there is a history of a previous injury. (Recommendation based on moderate evidence.) RISK FACTORS – ANKLE INSTABILITY: Clinicians should recognize the increased risk for developing ankle instability in patients who (1) have an increased talar curvature, (2) are not using an external support, or (3) did not perform balance or proprioception exercises following an acute lateral ankle sprain. (Recommendation based on weak evidence.) Clinicians should use the clinical findings of level of function , ligamentous laxity, hemorrhaging, point tenderness, total ankle motion, swelling, and pain to classify a patient with acute ankle ligament sprain into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of sprain and strain of ankle (S93.4), and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of ankle stability (b7150 stability of a single joint) and movement coordination impairments (b7601 control of complex voluntary movements). (Recommendation based on moderate evidence.) DIAGNOSIS/CLASSIFICATION – ANKLE INSTABILITY: Clinicians may incorporate a discriminative instrument, such as the Cumberland Ankle Instability Tool, to assist in identifying the presence and severity of ankle instability associated with the ICD category of disorder of ligament, instability secondary to old ligament injury, ankle and foot (M24.27), and the associated ICF impairment-based category of ankle stability (b7150 stability of a single joint) and movement coordination impairments (b7601 control of complex voluntary movements). (Recommendation based on moderate evidence.) Clinicians should use diagnostic classifications other than an acute lateral ankle sprain when the patient's reported activity limitations or impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline. Particularly , the Ottawa and Bernese ankle rules should be used to determine whether a radiograph is required to rule out a fracture of the ankle and/or foot. (Recommendation based on strong evidence.) DIFFERENTIAL DIAGNOSIS – ANKLE INSTABILITY: Clinicians should use diagnostic classifications other than ankle instability when the patient's reported activity limitations or impairments of body function and structure …