Case Study Review: Evaluating a Collegiate Basketball Player With an Acute Ankle Injury

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Ankle injuries are among the most common issues encountered in collegiate athletics, particularly in sports that involve jumping, cutting, and rapid changes of direction. This case study walks through the assessment of an acute ankle injury in the athletic training room, highlighting how a solid history, focused clinical exam, and proper use of decision rules, like the Ottawa Ankle Rules, help determine whether an injury is a sprain, strain, or possible fracture.

Athlete Presentation

A 20-year-old male collegiate basketball player reports to the athletic training room the morning after practice with significant right ankle pain. He notes that during a rebounding drill, he landed on another player’s foot and his ankle rolled inward. He immediately felt sharp pain and was unable to continue practicing.

He arrives non–weight bearing and reports:

• Lateral ankle pain and swelling
• Bruising that developed overnight
• Difficulty bearing weight—even for a few steps
• No previous ankle fractures, but one mild sprain during high school
  

When asked about the mechanism, he describes classic inversion with plantarflexion—one of the most common mechanisms for lateral ankle sprains.

History Points You Should Always Cover

A thorough history sets the tone for the rest of your evaluation. Key questions include:

• Exact mechanism (inversion, eversion, rotation?)
• Time since injury
• Ability to walk immediately after the injury and at present
• Location and quality of pain
• Numbness, tingling, or temperature/color changes
• Prior ankle injuries or chronic instability
• Any audible “pop” or sensation of shifting
• Training load or fatigue leading up to the injury

Clinical Examination in the Athletic Training Room

On exam, the athlete presents with:

• Noticeable swelling and ecchymosis along the lateral ankle
• Warmth without any open wounds
• Intact pulses and normal capillary refill
• No deformity
• Significant tenderness on palpation of:
  
  • The lateral malleolus (posterior edge)
  • The ATFL region
  • The base of the 5th metatarsal (mild)
    

Functional tests included:

• Active and passive ROM: Pain with inversion and plantarflexion
• Anterior drawer: Guarding makes it difficult to interpret, but possible laxity
• Thompson test: Normal, ruling out Achilles rupture
• Weight-bearing assessment: Unable to take four full steps
  

Given the acuteness of the injury and the severity of pain, the exam is limited but still useful for decision-making.

Using the Ottawa Ankle Rules in Your Decision

The Ottawa Ankle Rules help determine whether an athlete needs imaging to rule out a fracture. For ankle imaging to be indicated, one of the following must be present:

• Pain in the malleolar zone AND tenderness over the posterior edge or tip of the lateral or medial malleolus

OR

• Pain in the malleolar zone AND inability to bear weight immediately after the injury and for four steps in the athletic training room

Our basketball player meets the criteria:

• Clear tenderness at the posterior edge of the lateral malleolus
• Inability to bear weight
  

Based on this, the athletic trainer refers the athlete to the team physician for further evaluation and imaging.

Team Physician Findings

The team physician orders an X-ray of the ankle. Results show:

• No fracture or bony abnormality

The athlete is diagnosed with a moderate (Grade II) lateral ankle sprain.

Initial treatment includes:

• Compression wrap
• Elevation and icing
• Protected weight-bearing
• Instructions to avoid basketball activities
• A follow-up plan with the athletic training staff
  

The team physician also places the athlete in a walking boot for the first week to improve protection and reduce swelling.

Rehabilitation Program

Over the next four weeks, the athlete works through:

• Edema control and early ROM
• Isometric and isotonic strengthening
• Balance and proprioception training
• Progressive sport-specific drills
• Controlled return-to-play progressions
  

By week six, he regains nearly full ankle function, with no significant pain or swelling. He completes a functional return-to-sport assessment before resuming full basketball participation.

Summary for Athletic Training Students

This case reinforces the value of:

• Asking targeted history questions
• Understanding mechanism-based injury patterns
• Using a structured exam, even when pain limits full assessment
• Applying the Ottawa Ankle Rules appropriately
• Knowing when to refer for imaging
• Coordinating care with team physicians and supervising clinicians
  

A careful initial evaluation, paired with evidence-based decision-making, helps distinguish between sprains, strains, and fractures and ensures athletes receive the right level of care promptly.