Ankle Instability

Ankle sprains are the most frequent musculoskeletal injury and have a high propensity for the development of permanent symptoms. Establishing the mechanism of injury is the first step of an ankle trauma evaluation, raising suspicion over which structures were affected. An inversion-supination trauma will affect mostly the lateral ligamentar complex, while an external rotation-pronation trauma will originate syndesmosis and deltoid ligament stress. The clinical examination should be meticulous in order to avoid missing potentially serious injuries. Stress tests for lateral, syndesmosis, and medial ligaments are an essential tool to evaluate ligament laxity and potential ruptures. There are some innovations on lateral ankle instability examination, with the introduction of the ankle pivot test and the modification of the talar tilt test. The radiological examination will confirm suspected lesions. While more traditional methods continue to have their space, magnetic resonance imaging is gaining relevance as the gold standard for evaluating ankle ligamentar injuries.