The history is often of a fall down a stair, or stumbling over an unexpected obstacle, where the ankle is twisted severely under the leg. The ankle rapidly becomes swollen and the injury may cause a marked deformity.
On examination the ankle may be tender on both sides (because of injury to both malleoli).
X-rays of the ankle should be taken from at least three different angles if the nature of the injury is to be fully appreciated. A proximal fibular fracture may also need to be excluded.
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