Although knowledge of the mechanism of the injury is important, many patients can not recollect the exact movement that caused the injury. The classification systems used to describe ankle injuries utilize the direction of the deforming force to describe the potential injury. This information is useful, but, to emergency physicians, the circumstances surrounding the injury are of greater importance in consideration of other injuries. The potential for associated injuries is greater in an individual who has jumped from a 12-foot fence than in a basketball player who came down on one foot from a hoop jump. Likewise, an elderly woman is more likely to have a second injury when she trips on a curbstone and falls to the pavement on an outstretched hand. The treatment of patients who have chronic medical conditions like diabetes or peripheral vascular disease, which can cause sensory deficits, or who are on chronic immunosuppressive therapy has to be approached with caution. A normal-appearing ankle or minimal tenderness on examination does not exclude the necessity of further evaluation. The ability to bear weight immediately after an injury, with subsequent increase in pain and swelling as the patient continues to ambulate, suggests a sprain rather than a fracture. Finally, the time of the injury, as well as previous bony or soft tissue injuries to the ankle, need to be documented.
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