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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTkwNzIyOS1vdmVydmlldw==\nDrugs & Diseases > Sports Medicine\nAuthor: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD more...\nSections Ankle Sprain\nEvaluation for Chronic Instability\nWorkup\nApproach Considerations\nPlain Radiographic Imaging\nStress-View Radiographic Imaging\nComputed Tomography Scanning\nArthrographic Imaging\nBone Scanning\nConservative Therapy for Acute Sprain\nAnkle taping\nPain Control for Acute Sprain\nConservative Therapy for Chronic Sprain\nIndications for Surgical Intervention\nWhen to Return to Normal Activity\nLong-Term Complications\nMedication Summary\nNonsteroidal anti-inflammatory drugs\nAn ankle sprain is usually that of an inversion-type twist of the foot, followed by pain and swelling. The most commonly injured site is the lateral ankle complex, which is composed of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. [1, 2, 3, 4]\nSigns and symptoms of an ankle sprain include the following:\nPain/tenderness\nCold foot or paresthesia (possible neurovascular compromise) [1]\nSee Clinical Presentation for more detail.\nThe physical examination confirms a diagnosis made on the basis of patient history and differentiates an ankle sprain from a fracture. Examination in patients may include the following tests:\nAnterior drawer test: To assess for ankle instability (see the image below)\nAnterior drawer test.\nProne anterior drawer test: Also tests for ligamentous instability\nTalar tilt test (or inversion stress maneuver): To assess integrity of the calcaneofibular ligament (see the image below)\nTalar tilt test.\nExternal rotation test: To evaluate the integrity of the syndesmotic ligaments\nKleiger test: Variation of the external rotation test; to assess the integrity of the deltoid ligament\nSqueeze test (or fibular compression test): To evaluate for syndesmotic or fibular injury\nNeurovascular evaluation: To assess neurovascular status of the affected limb\nImaging studies\nThe following radiologic studies may be used to evaluate ankle sprains:\nPlain radiography: Guided by the Ottawa Ankle Rules to diagnose ankle or foot fractures\nStress-view radiography: May provide further assessment for ankle stability; accuracy of study increases with use of local anesthesia\nComputed tomography scanning: May be indicated for imaging of soft tissues or for bone imaging beyond radiography; useful for evaluating osteochondritis dissecans and stress fractures\nMagnetic resonance imaging: May be useful to assess a suspected syndesmotic or high ankle sprain or if osteochondrosis or meniscoid injury is suspected in patients with a history of recurrent ankle sprains and chronic pain [5, 6]\nAnkle arthrography: May be useful for determining capsular damage and the number of ankle ligaments damaged\nBone scanning: To detect subtle bone abnormalities (eg, stress fracture, osteochondral defects) and syndesmotic disruptions\nSee Workup for more detail.\nConservative therapy\nConservative therapy for acute ankle sprains may be described by the acronyms RICE (rest, ice, compression, and elevation) and PRICES (combination of protection, relative rest, ice, compression, elevation, and support). Protective devices include air splints or plastic and Velcro braces. Ankle taping can also increase ankle stability, but its effectiveness is highly dependent on the expertise of the individual who performs the taping.\nPhysical therapy during the recovery phase is aimed at the patient regaining full range of motion, strength, and proprioceptive abilities, and may include the following:\nStrengthening exercises: Starts with isometric exercises, then advances to use of elastic bands or surgical tubing\nProprioception rehabilitation: Starts with single-leg-stance exercise in a single plane, then progresses to multiplanar exercises\nOther exercises: Uses a balance or tilt board, then advances to functional drills, jogging, sprinting, and cutting, and then progresses to figure-of-eight and carioca drills [7]\nThe following medications are used in the management of ankle sprain:\nAnalgesics (eg, acetaminophen)\nNonsteroidal anti-inflammatory agents (eg, ibuprofen, naproxen)\nIn most patients, there is no improved outcome with operative repair of third-degree anterior talofibular ligament tears and medial ankle ligament tears.\nIndications for operative intervention in patients with an ankle sprain include the following:\nDistal talofibular ligament third-degree sprain that causes widening of the ankle mortise\nDeltoid sprain with the deltoid ligament caught intra-articularly and with widening of the medial ankle mortise\nIn selected young patients with high athletic demands who have both anterior talofibular and calcaneofibular complete ruptures\nSurgical procedures for chronic ankle instability and sprains include the Watson-Jones procedure, the Evans procedure, and the Chrisman-Snook procedure.\nSee Treatment and Medication for more detail.\nThe history of an ankle sprain is usually that of an inversion-type twist of the foot followed by pain and swelling. An individual with an ankle sprain can almost always walk on the foot, albeit carefully and with pain.\nIn an individual with normal local sensation and cerebral function, the ability to walk on the foot usually excludes a fracture. (See Clinical Presentation.) Suspect neurovascular compromise if the patient reports a cold foot or describes paresthesias. [1] Bone tenderness in the posterior half of the lower 6 cm of the fibula or tibia and the inability to bear weight immediately after the injury and in the emergency department are indications to obtain radiographic imaging. These Ottawa ankle rules have been validated for patients aged 5-55 years. [8, 9]\nAnkle sprains are classified into the following 3 grades:\nGrade 1 injuries involve a stretch of the ligament with microscopic tearing but not macroscopic tearing. Generally, little swelling is present, with little or no functional loss and no joint instability. The patient is able to fully or partially bear weight.\nGrade 2 injuries stretch the ligament with partial tearing, moderate-to-severe swelling, ecchymosis, moderate functional loss, and mild-to-moderate joint instability. Patients usually have difficulty bearing weight.\nGrade 3 injuries involve complete rupture of the ligament, with immediate and severe swelling, ecchymosis, an inability to bear weight, and moderate-to-severe instability of the joint. Typically, patients cannot bear weight without experiencing severe pain.\nDrawer and talar tilt examination techniques are used to assess ankle instability; however, the use of these techniques in acute injuries is in question because of pain, edema, and muscle spasm.\nPain reduction is essential, but improvement of any loss of motion, strength, and/or proprioception is equally important. [10, 11, 12] Rest, ice, compression, and elevation (ie, RICE) are the mainstays of acute treatment; more comprehensively, the combination of protection, relative rest, ice, compression, elevation, and support (PRICES) is used. [1] (See Treatment.)\nPhysical therapy during the recovery phase is aimed at the patient regaining full range of motion (ROM), strength, and proprioceptive abilities.\nFor recurrent lateral ankle sprains, treatment should begin with a trial of conservative therapy for approximately 2-3 months. The recurrence rate for lateral ankle sprains has been reported to be as high as 80%. [13, 14]\nIt is generally accepted that for most patients, operative repair of third-degree anterior talofibular ligament (ATFL) tears and medial ankle ligament tears does not contribute to an improved outcome. One of the few absolute indications for surgery in patients with a sprained ankle is a distal talofibular ligament third-degree sprain that causes widening of the ankle mortise. A second indication is a deltoid sprain with the deltoid ligament caught intra-articularly and with widening of the medial ankle mortise.\nThe ankle joint is a hinged synovial joint with primarily up-and-down movement (plantar flexion and dorsiflexion). The other joints around the ankle are responsible for other movements, giving the ankle a total range of motion (ROM) comparable to that of a ball and socket. The combined movement in the dorsiflexion and plantarflexion directions is greater than 100°; bone-on-bone abutment beyond this range protects the anterior and posterior ankle capsular ligaments from injury. The anterior and posterior ankle capsular ligaments are relatively thin compared with the medial and lateral ankle ligaments.\nThe lateral ankle complex, which is composed of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, is the most commonly injured site. [1, 2, 3, 4] Approximately 85% of such sprains are inversion sprains of the lateral ligaments, 5% are eversion sprains of the deltoid or medial ligament, and 10% are syndesmotic injuries. The ATFL is the most likely component of the lateral ankle complex to be injured in a lateral ankle sprain. Osteochondral or chondral injuries of the talar dome should be considered when diagnosing an ankle injury.\nDuring forced dorsiflexion, the PTFL can rupture. With forced internal rotation, ATFL rupture is followed by injury to the PTFL. Extreme external rotation disrupts the deep deltoid ligament on the medial side, and adduction in neutral and dorsiflexed positions can disrupt the CFL. In plantarflexion, the ATFL can be injured.\nThe strongest ankle capsule-ligament complex is the deltoid ligament, which has 2 parts: the superficial component and the deep component. The superficial component runs the farthest from the medial malleolus to the medial aspect of the calcaneus, posteriorly. The medial malleolus usually fractures before the deltoid ligament fails mechanically.\nAnkle spurs may occur at any of the bony ligament attachments. On lateral radiographs, it is not uncommon to see an anterior spur at the neck of the talus, where the anterior ankle capsule attaches. This is caused by ossification of the hematoma organization associated with anterior ligament sprains.\nBecause of its great strength, the syndesmotic ligament, which has a deep portion between the bones and superficial, anterior, and posterior portions, is rarely sprained. This distal tibiofibular ligament holds the distal tibia and fibular bones together at the ankle joint and maintains the integrity of the ankle mortise. It takes a great amount of force to strain this ligament, which normally does not have much excursion. A significant tear of this ligament requires surgical treatment. Severe posttraumatic arthritis of the tibiotalar joint (ankle) can result quickly if a syndesmosis tear remains unrecognized and untreated. A syndesmotic ligament tear is usually a part of an ankle fracture that needs to be treated specifically. This is not generally true of the other ankle ligament tears.\nMechanical forces exceeding the tensile limits of the ankle joint capsule and supportive ligaments cause ankle sprains.\nThere are a number of contributing factors, which can be classified as either predisposing or provocative, as follows:\nPredisposing factors can result from a lack of physical conditioning; they include poor muscle tone and shortened and/or contracted joint capsule or tendons. Poor proprioception can also be a factor, as can inadequate training or experience with the physical activity being performed.\nProvocative factors include accidents and other unforeseen circumstances that result in mechanical stresses that exceed the tensile limits of the ankle joint capsule and ligaments. Obesity can contribute to sprains by increasing kinetic energy to a point that exceeds joint-design stress limits.\nA cohort study analyzed risk factors in ankle injuries from the Cadet Illness and Injury Tracking System (CIITS) database at the United States Military Academy (USMA) from 2005-2009. The results found higher risk of syndesmotic ankle sprains in males who performed at a higher level of athletic competition; male athletes were 3 times more likely to experience medial ankle sprains than female athletes. [15]\nRecurrent sprains\nThe exact etiology of recurrent ankle sprains is unknown; however, many factors may play a role.\nOne possibility is that recurrent sprains result primarily from ligaments healing in a lengthened position due to scar tissue filling in the gap between the torn, separated ends. Furthermore, the weakness of the healed ligament may be due to the inherent weakness of the scar.\nIn a study by Bosien et al, 22% of patients with recurrent ankle sprains had persistent peroneal weakness. [16] The authors believed that this contributed to recurrent injury, especially in incompletely rehabilitated ankle sprains.\nAn unrecognized disruption of the distal tibiofibular ligament has been cited as a potential culprit. This condition is diagnosed based on tenderness over the anterior syndesmosis and pain when the fibula is squeezed against the tibia at midshaft, with dorsiflexion and external rotation or with excessive medial-lateral motion of the tibiotalar joint.\nFreeman et al suspected that functional instability that resulted in recurrent sprains was secondary to loss of proprioception in the foot. [17] Mechanoreceptors and their afferent nerve fibers have been shown to exist in the ligaments and capsule of the ankle. Furthermore, disruption of the ligaments and joint capsule with a grade 3 sprain (a complete ligament tear; see Clinical Presentation) leads to impairment of the reflex stabilization of the foot, causing the foot to give way. [18] In addition, dysfunction of the peroneal nerve can result in delayed muscle response, causing a delay in the activation of the peroneal muscles and leading to functional instability.\nImpingement by the distal fascicle of the AITF ligament and/or impingement of the capsular scar tissue in the talofibular joint is another cause, and hereditary hypermobility of joints is an additional suggested etiologic factor.\nMost ankle sprains are probably self-treated and are never reported to a health care provider; therefore, many ankle sprains are not documented. Sprained ankles have been estimated to constitute up to 30% of injuries seen in sports medicine clinics and are the most frequently seen musculoskeletal injury seen by primary care providers. [19] More than 23,000 people per day in the United States, including athletes and nonathletes, require medical care for ankle sprains. Stated another way, incident cases have been estimated at 1 case per 10,000 persons per day. [20] A U.S. Army study found that ankle sprains are the most common foot and ankle injury in active-duty Army personal with a rate of 103 sprains per 1000 persons per year. [21]\nFemale athletes are 25% more likely to sustain ankle injuries than male athletes. Female basketball players are at a higher risk of a first-time inversion injury than those participating in other sports. [22] Soccer and volleyball are other leading causes of ankle sprains in high school and college female athletes. [23, 24] Some studies attribute a higher incidence of ankle injuries in high school football, basketball, and soccer players. [23, 25, 26] Other studies conclude that in college men, the risk of suffering an ankle sprain appears to be similar with basketball, soccer, and football. [22]\nAnkle injuries are very common, with ankle sprain being the most common injury. Most individuals have complete recovery; however, a substantial number have chronic problems that usually lead to modification of physical activity. [27]\nThe prognosis for isolated and adequately treated ankle sprains is excellent. The prognosis for a patient with ankle sprains and other traumatic injuries is related to the prognosis for the other injuries.\nIn a systematic literature review, 36-85% of patients with acute ankle sprains reported full recovery at 2 weeks to 36 months, independent of the initial grade of sprain, [28] with most recovery occurring within the first 6 months. [29] After 12 months, the risk of recurrent ankle sprain returns to preinjury levels. [30] However, 3-34% of patients reported re-sprains at 2 weeks to 96 months after the initial injury. Furthermore, after 3 years, some patients still had residual pain and instability. One risk factor for residual symptoms seems to be participation in competitive sports. [28]\nIf recurrent ankle sprains are treated early and appropriate rehabilitation is initiated, the prognosis is excellent with conservative treatment. [31, 32, 33] The prognosis becomes even more important to consider for patients who require surgical correction. Reconstructive procedures can vary significantly in their ability to correct any persistent instability.\nWith respect to chronic syndesmotic sprains, long-term outcome studies are few in number. In a study conducted at West Point, all patients who were studied returned to full duty without further problems. One of these patients was surgically treated, and all had full ROM of the ankle. [34]\nIn 6 cases of frank diastasis over 4- to 60-month follow-up, 4 cases had good results, and 2 had fair results in that the patients had residual mild ankle pain and restricted ROM, according to Edwards and DeLee. There was 1 case of postoperative skin slough that healed uneventfully, and 1 fixation device failed. [35]\nIn 5 patients with subacute or chronic syndesmotic injury, all of the affected ankles achieved fusion with no complications within 10 weeks, in a study by Katznelson et al. Each patient was treated with operative stabilization and bone grafting to the tibiofibular joint, which formed a synostosis. One patient developed traumaticosteoporosis that resolved in 6 months; this patient had mild loss of dorsiflexion. [36]\nResults are limited for subtalar instability, because this condition is mostly recognized during surgery for chronic lateral ligamentous instability. Most of the available results are intermingled with the results of lateral ankle procedures.\nChrisman and Snook had 3 patients with subtalar and ankle instability that were treated by their eponymous procedure. [37] One patient had a failed Watson-Jones procedure with persistent instability. The 3 patients with subtalar instability had a 20° limitation of inversion compared with the opposite, normal side. These patients had no symptoms of instability at 2- to 6 year follow-up. [38]\nPosttraumatic osteoarthritis is common in patients with repetitive ankle injuries. One study estimates that approximately 12% of the overall prevalence of osteoarthritis (OA) is in fact posttraumatic OA of the hip, knee, or ankle. The financial burden is significant, estimated at $3.06 billion dollars annually. [39]\nReview the self-care techniques of acute sprain with patients so that they can take an active part in their care. Teach them the mnemonic PRICES, as follows:\nRelative rest\nProvide patients with information on when to call for advice. Instruct them to call a doctor or nurse if one of the following conditions is observed:\nThe joint is wobbly or moves past its normal ROM\nThe bone is deformed or bends abnormally\nPain prevents putting weight on the injured area after 24 hours\nWeight-bearing still is difficult after 4 days\nExtreme pain, bruising, or severe swelling is present\nThe toes below the injury feel cold to the touch or become numb or blue\nThese instructions can be tailored to each practice and by no means should be construed as all-inclusive.\nFor patient education resources, see the patient education articles Ankle Sprain and Sprains and Strains.\nIvins D. Acute ankle sprain: an update. Am Fam Physician. 2006 Nov 15. 74(10):1714-20. [Medline].\nANDERSON KJ, LECOCQ JF, CLAYTON ML. Athletic injury to the fibular collateral ligament Of the ankle. Clin Orthop. 1962. 23:146-61. [Medline].\nGross MT, Liu HY. The role of ankle bracing for prevention of ankle sprain injuries. 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Validation of the Ottawa Ankle Rules in children with ankle injuries. Acad Emerg Med. 1999 Oct. 6(10):1005-9. [Medline].\nDeLee Jc, Drez D Jr, eds. Orthopaedic Sports Medicine: Principles and Practice. vol 2. Philadelphia, PA: WB Saunders; 1994. 1718-24.\nSinger KM, Jones DC. Ligament injuries of the ankle and foot. Nicholas JA, Hershman EB, eds. The Lower Extremity and Spine in Sports Medicine. 2nd ed. St Louis, MO: Mosby; 1995. vol 2.: 475-97.\nWindsor RE. Overuse injuries of the leg, ankle and foot. Phys Med Rehabil Clin North Am. 1994. 475-97.\nHertel J. Functional instability following lateral ankle sprain. Sports Med. 2000 May. 29(5):361-71. [Medline].\nSafran MR, Benedetti RS, Bartolozzi AR 3rd, Mandelbaum BR. Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis. Med Sci Sports Exerc. 1999 Jul. 31(7 Suppl):S429-37. [Medline].\nWaterman BR, Belmont PJ Jr, Cameron KL, Svoboda SJ, Alitz CJ, Owens BD. 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Bracing and rehabilitation--what's new. Clin Sports Med. 2004 Jan. 23(1):83-95. [Medline].\nLohrer H, Alt W, Gollhofer A. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med. 1999 Jan-Feb. 27(1):69-75. [Medline].\nManfroy PP, Ashton-Miller JA, Wojtys EM. The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance of ankle inversion. Am J Sports Med. 1997 Mar-Apr. 25(2):156-63. [Medline].\nDe Ridder R, Willems TM, Vanrenterghem J, Roosen P. Effect of tape on dynamic postural stability in subjects with chronic ankle instability. Int J Sports Med. 2015 Apr. 36:321-6. [Medline].\nStanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. 1998 Apr. 17(2):375-92. [Medline].\nMcCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. 1998 Nov 2. 105(5A):3S-9S. [Medline].\nDoherty C, Bleakley C, Delahunt E, Holden S. 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Foot Ankle Int. 1998 Oct. 19(10):653-60. [Medline].\nLöfvenberg R, Kärrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995 Jul-Aug. 23(4):414-7. [Medline].\nBalduini FC, Tetzlaff J. Historical perspectives on injuries of the ligaments of the ankle. Clin Sports Med. 1982 Mar. 1(1):3-12. [Medline].\nFong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007. 37(1):73-94. [Medline].\nCurtis CK, Laudner KG, McLoda TA, McCaw ST. The role of shoe design in ankle sprain rates among collegiate basketball players. J Athl Train. 2008 May-Jun. 43(3):230-3. [Medline]. [Full Text].\nMcGuine TA, Brooks A, Hetzel S. The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players. Am J Sports Med. 2011 Sep. 39(9):1840-8. [Medline].\nFousekis K, Tsepis E, Vagenas G. Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players. Am J Sports Med. 2012 Aug. 40(8):1842-50. [Medline].\nLynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute Lower Extremity Injury Rates Increase following Concussion in College Athletes. Med Sci Sports Exerc. 2015 Jun 8. [Medline].\nde Vasconcelos GS, Cini A, Sbruzzi G, Lima CS. Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis. Clin Rehabil. 2018 Dec. 32 (12):1581-1590. [Medline].\nWang Y, Gu Y, Chen J, Luo W, He W, Han Z, et al. Kinesio taping is superior to other taping methods in ankle functional performance improvement: a systematic review and meta-analysis. Clin Rehabil. 2018 Nov. 32 (11):1472-1481. [Medline].\nTilt board.\nstrengthening using an elastic band.\nExample of a lace-up ankle support. Courtesy of Swede-O, Inc.\nExample of a brace for immobilization or functional purposes. Courtesy of Swede-O, Inc.\nExample of a brace that can be used for functional purposes. Courtesy of Swede-O, Inc.\nExample of a brace secured with Velcro straps. Courtesy of Swede-O, Inc.\nExample of a lace-up ankle support brace with figure-8 straps. Courtesy of Swede-O, Inc.\nCraig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin\nCraig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa\nSherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine\nSherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine\nDisclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.\nMichael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine\nMichael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists\nDisclosure: Allergan Honoraria Speaking and teaching\nDavid T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health\nDavid T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine\nEdward Bessman, MD, MBA Chairman and Clinical Director, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine\nEdward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine\nJoseph R Bozzelle, Jr, MD Director, Rehabilitation Services, Crowley Rehabilitation Hospital, Doctors Hospital of Opelousas, Southwest Medical Center\nJoseph R Bozzelle, Jr, MD is a member of the following medical societies: Louisiana State Medical Society\nKenneth R Chuang, MD Attending Physician, Emergency Department, Long Beach Memorial Medical Center and Miller Children's Hospital\nJohn S Early, MD Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship, Baylor University Medical Center\nJohn S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association\nDisclosure: AO North America Honoraria Speaking and teaching; Stryker Consulting fee Consulting; Biomet Consulting fee Consulting; AO North America Grant/research funds fellowship funding; MMI inc Honoraria Speaking and teaching; Osteomed Consulting fee Consulting; MedHab Inc Management position\nStephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans\nStephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine\nJames Monroe Laborde, MD, MS Clinical Assistant Professor, Department of Orthopedics, Louisiana State University Health Sciences Center and Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School\nJames Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons\nConsuelo T Lorenzo, MD Executive Health Resources\nConsuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation\nMircea Muresanu, MD Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn\nMircea Muresanu, MD, is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association\nAntonia Quinn, DO Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Assistant Residency Director, Attending Physician, Department of Emergency Medicine, Kings County Hospital Center, SUNY Downstate Medical Center\nAntonia Quinn, DO is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine\nMarlon P Rimando, MD, CSCS Assistant Clinical Professor, Department of Medicine, University of Hawaii, John A Burns School of Medicine; Founder, Pacific Health and Fitness Consultants\nMarlon P Rimando, MD, CSCS is a member of the following medical societies: National Strength and Conditioning Association\nTom Scaletta, MD Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine\nTom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine\nDisclosure: Medscape Salary Employment\nRobert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine\nRobert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association\nencoded search term (Ankle Sprain) and Ankle Sprain\nAnkle Fracture in Sports Medicine\nWrist Dislocation in Sports Medicine\nBrachial Plexus Injury in Sports Medicine\nCervical Spine Acute Bony Injuries in Sports Medicine\nAtlantoaxial Injury and Dysfunction\nHumeral Capitellum Osteochondritis Dissecans\nHow a Soccer Player Became a Physician for US Teams\nSports Medicine Group Issues Guidance on Athletes' Mental Health\nHappier or Not? 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