Evaluation and Management of Ankle Injuries in Urgent Care (Trauma CME)

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Delivery Method:	Online
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Publication Date: February 2025 (Volume 4, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 02/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Ankle injuries represent a significant portion of extremity traumas seen in urgent care settings, with acute ankle sprains being among the most common musculoskeletal injuries. This review provides a framework for evaluating and managing ankle injuries in urgent care by discussing outline common presentations, differential diagnoses, and indications for urgent orthopedic referral. Etiology, pathophysiology, and treatment options for various ankle injuries, including ligamentous injuries, fractures, and tendinopathies are also discussed.

Case Presentations

A 42-year-old woman presents to urgent care and states that she lost her balance yesterday when walking near a sidewalk and stepped down “wrong”…

• On examination, the patient refuses to bear weight on her left ankle for fear of pain.
• You notice swelling on the left lateral ankle but no ecchymosis. She has tenderness to palpation over the lateral malleolus and anterior talofibular ligament. The varus/valgus stress test is normal, and the anterior drawer test of her left ankle causes discomfort, but no joint laxity is appreciated. Her toes have normal capillary refill bilaterally.
• You order 3-view left ankle x-ray.
• You wonder if this is an ankle sprain or a possible fracture…

A 34-year-old man presents to urgent care with right ankle/distal calf pain after playing basketball…

• The injury occurred just prior to arrival. He heard and felt a pop in the back of the right ankle when he quickly stopped and changed directions to run forward.
• He notes pain is 7/10 and is unable to bear weight on the affected ankle/foot. On examination he has tenderness to palpation over the Achilles tendon, and you appreciate mild swelling at the right heel.
• The patient is unable to stand on his toes on the right side. His Thompson test is positive on the right. His toes have normal capillary refill bilaterally.
• Based on this mechanism of injury and presentation, what injuries are you concerned for?

A 25-year-old man who fell from a ladder and twisted his right ankle when landing presents to urgent care…

• The patient’s injury occurred earlier this morning, about 4 hours ago. He lost his balance and fell about 2 feet from the ladder to the ground. On landing, he twisted his right ankle and felt immediate pain.
• The patient is unable to bear weight on right ankle secondary to pain. On examination he has pain and swelling noted on the right lateral malleolus. He is unable to tolerate an anterior drawer test of the right ankle or varus/valgus stress testing. He is able to dorsiflex and plantar flex the right ankle. His toes have normal capillary refill bilaterally.
• You order 3-view x-rays of the right ankle and right foot.
• You wonder if it’s a possible fracture due to his mechanism of injury and physical examination…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.