A 21-year-old man injures his ankle during a beach volleyball game. He bears weight and the ankle is swollen and discolored; tenderness is worse on passive inversion. There is no bony tenderness on percussion of the malleolus, fibula, or tarsal bones. What is the initial impression?

A 21-year-old man injures his ankle during a beach volleyball game. He bears weight and the ankle is swollen and discolored; tenderness is worse on passive inversion. There is no bony tenderness on percussion of the malleolus, fibula, or tarsal bones. What is the initial impression?

• A. Sprain / strain
• B. Tarsal Tunnel Syndrome
• C. Pott's ankle fracture
• D. Achilles tendon rupture

Answer: (A)

When an inversion injury occurs, tearing of the lateral ankle ligaments is the most common problem. The combination of swelling, discoloration, and focal tenderness that worsens with passive inversion points toward a soft tissue ligament sprain rather than a fracture. The lack of bony tenderness on tapping the malleoli, fibula, or tarsal bones makes a fracture unlikely, supporting a sprain as the initial impression. Tarsal tunnel syndrome would produce nerve-related symptoms such as numbness or burning in the foot, often chronic and not tied to an acute inversion event. A Pott’s ankle fracture would typically present with focal bone tenderness and possibly deformity after a forceful event. An Achilles tendon rupture usually presents with severe pain at the back of the ankle and difficulty with plantarflexion, not primarily with inversion-related tenderness.

When an inversion injury occurs, tearing of the lateral ankle ligaments is the most common problem. The combination of swelling, discoloration, and focal tenderness that worsens with passive inversion points toward a soft tissue ligament sprain rather than a fracture. The lack of bony tenderness on tapping the malleoli, fibula, or tarsal bones makes a fracture unlikely, supporting a sprain as the initial impression.

Tarsal tunnel syndrome would produce nerve-related symptoms such as numbness or burning in the foot, often chronic and not tied to an acute inversion event. A Pott’s ankle fracture would typically present with focal bone tenderness and possibly deformity after a forceful event. An Achilles tendon rupture usually presents with severe pain at the back of the ankle and difficulty with plantarflexion, not primarily with inversion-related tenderness.