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Am Fam Physician. 1998;58(4):864-866

to the editor: Dr. Wexler's article,1 “The Injured Ankle,” should have mentioned that tibiofibular diastasis, which is easily seen on the anteroposterior view of the ankle (compare with the normal side if necessary), is a common cause of “late” ankle sprain pain. Also, early magnetic resonance imaging (MRI) of the talus can help in the diagnosis of undisplaced talus dome fractures.

in reply: I agree with Dr. Tom that tibiofibular diastasis is a cause of “late” ankle sprains. Not only may it be noticed on routine radiographs, but clinically it may be inferred on physical examination. Pain elicited by placing pressure on the distal portion of the tibiofibular complex can signal such a condition, and it can be confirmed with diagnostic imaging.

I disagree, however, with the suggestion that an “early” MRI is appropriate in the evaluation of ankle injury. The physical examination, history and radiographs are adequate initial components in the diagnosis of an injured ankle. Expensive diagnostic tests should be reserved for difficult and refractory cases.

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