Evolution of ankle sprains: What correlations exist between subjective symptoms and objective signs

Title : Evolution of ankle sprains: What correlations exist between subjective symptoms and objective signs

Abstract:

Introduction and Objective: The outcome of ankle sprains varies considerably among patients, and the available literature does not provide a clear understanding of the factors influencing this evolution. The aim of this study was to investigate the correlations between subjective symptoms and objective clinical signs one year after a lateral ankle sprain.

Materials and Methods: A prospective observational study was conducted on 103 patients with lateral ankle sprains, assessed after a 12-month follow-up period. The study was carried out between 2018 and 2021 among patients referred for Physical and Rehabilitation Medicine (PRM) management at the Regional University Military Hospital of Oran following an ankle sprain.

Results: The study population consisted predominantly of men (96%), with a mean age of 28 years. Severe sprains accounted for 37% of cases, moderate sprains for 59%, and mild sprains for 4%. The mean duration of sick leave was 48 days, while workplace adaptations were required in 27% of cases. Recurrences occurred in 18% of patients. At least one sequela was identified in 69% of cases. Subjective sequelae included exertional pain in 60% of patients, functional instability in 27%, and gait apprehension in 50%. Objective findings included clinical ligamentous laxity in 27% of cases, edema in 31%, and stiffness in 19%. Edema and stiffness were significantly associated with exertional pain (p < 0.001 and p = 0.002, respectively), functional instability (p = 0.011 and p = 0.011), and gait apprehension (p < 0.001 and p = 0.002). Clinical laxity was significantly associated only with gait apprehension (p = 0.02). All subjective and objective sequelae were significantly associated with recurrence, except clinical laxity.

Discussion: The relatively high rate of functional sequelae observed in our study compared with the literature may be explained by the higher proportion of severe sprains. Indeed, patients were recruited from a PRM consultation setting, whereas most published studies include patients directly from emergency departments. Clinical ligamentous laxity assessed through ligament testing appears to be the least reliable indicator of functional impairment following an ankle sprain. These findings suggest that effective management and prevention of edema and stiffness may improve the functional prognosis of ankle sprains.

Keywords: ankle sprain, sequelae, functional prognosis, subjective symptoms, objective signs.

Biography:

Dr. Kheir-Eddine DIB, MD, PhD, is a Lecturer in Physical and Rehabilitation Medicine at a university hospital in Oran, Algeria. He obtained his Doctorate in Medical Sciences with a thesis focusing on the rehabilitation management of acute ankle sprains, a work that was subsequently presented at several national scientific meetings. His professional activities combine clinical practice, undergraduate and postgraduate medical education, and research in rehabilitation medicine. He is involved in the training of medical students and resident physicians while providing specialized consultations in Physical and Rehabilitation Medicine. His areas of interest include musculoskeletal rehabilitation, sports-related injuries, functional assessment, ankle disorders, and medical education. He is committed to advancing evidence-based rehabilitation practice and improving the quality of patient care and medical training.