[A not-so-typical ankle sprain]

An estimated hundreds of thousands of patients are treated in the Netherlands every year for an ankle sprain. We describe two cases where the course of an ankle sprain differed from the usual presentation.

Case 1: A 22-year-old male presented to the Emergency Department following an inversion sprain to the ankle. The pain and swelling were localized around the subtalar joint rather than the lateral ankle ligament(s), with limited range of motion in the subtalar joint. Imaging revealed a fracture through a tarsal coalition. The patient was treated with cast immobilization. Case 2: A 50-year-old male presented to the outpatient clinic with ankle pain after a previous ankle sprain. The symptoms involved pain and swelling around the talocrural joint with limited inversion and eversion. Imaging revealed a chronically fractured tarsal coalition. The patient was treated conservatively.

Not every ankle sprain resulting from an inversion injury is a typical lateral ankle sprain. Physicians should maintain clinical awareness for exceptional cases where a fractured tarsal coalition may mimic the symptoms of a lateral ankle sprain.