Entorse à la cheville

• Utilisez des soins culturellement adaptés qui tiennent compte des traumatismes et des violences. Expliquez pourquoi les questions sont importantes, demandez la permission avant d'aborder des sujets sensibles et adaptez la communication à la langue, à l'identité, à la culture, au handicap et aux expériences de soins de santé antérieures du patient (Agence de la santé publique du Canada, 2018).
  
• Informations sur le patient et le contexte : age; sex and gender when clinically relevant; preferred language and communication needs; work or school; caregiving; activity level; footwear or equipment; and the activities, roles and cultural or community connections important to the patient.

Principales préoccupations

• Injury and symptom course: mechanism and direction of force; date and setting of injury; immediate pain, swelling, bruising, sound or sensation; ability to continue activity and bear weight; care already received; and whether symptoms are improving, stable, fluctuating or worsening.
  
• Emplacement et motif : lateral, medial, anterior, posterior or pain above the ankle; foot or lower-leg symptoms; pain severity and irritability; swelling, stiffness, locking or catching; numbness, tingling, weakness, colour or temperature change; and the pattern with rest, loading and time of day.
  
• Aggravating and easing factors: walking, stairs, uneven ground, running, jumping, cutting, push-off, footwear, work or sport tasks, rest, support, elevation and self-management.
  
• Previous ankle and lower-limb history: first or recurrent sprain; prior fracture, surgery or rehabilitation; episodes of giving way; persistent instability; previous return to activity; and hip, knee, foot, balance or neurological concerns that may affect assessment or care.
  
• Revue des systèmes corporels : select relevant constitutional or general; eyes, ears, nose and throat; neurological; cardiovascular and vascular; respiratory; gastrointestinal; genitourinary; musculoskeletal and bone health; skin; endocrine or metabolic; haematologic or lymphatic; immune or infectious; mental health; and reproductive questions based on the presentation. Pursue findings that may change safety, the differential diagnosis, care or referral.
  
• Health and safety context: relevant bone health, diabetes or peripheral neuropathy, inflammatory or infectious illness, bleeding risk, medications and supplements, recent antibiotics, systemic corticosteroid or fluoroquinolone exposure, surgery or immobilization, and other factors that may change examination, healing, referral or use of the Ottawa Ankle Rules.
  
• Fonctionnement et participation aux activités : effects on sleep, mobility, self-care, work or school, caregiving, recreation, sport, community roles and confidence in the ankle.
  
• Social and access context: ask about relevant work or school demands and supports, caregiving, finances or compensation, housing, transportation, safety, discrimination, social support, access to care and culturally relevant or community supports. Use the information to adapt care when possible (Public Health Agency of Canada 2026).
  
• Soins et interventions antérieurs : advice, bracing or taping, mobility aids, medication, exercise, hands-on care or other approaches tried; benefits, adverse effects and reasons care was difficult to use or continue.
  
• Point de vue du patient : understanding of the injury, concerns about damage or reinjury, confidence, expectations, priorities, goals, preferences, cultural approaches and what meaningful recovery would look like.
  
• Signaler un avis : check Red Flags and refer to the separate fixed Orange Flags and Yellow Flags modules when relevant. Reassess relevant features when symptoms or functioning change.

​​Outcomes measures: Choose a small set that reflects the patient’s goals and can be repeated. Record a baseline and reassess often enough to guide decisions.

• Fonctionnement propre au patient : Échelle fonctionnelle propre au patient (PSFS).
• Handicap et participation : Échelle d'évaluation du handicap de l'OMS 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF or another suitable validated measure.
• Foot and ankle ability: Foot and Ankle Ability Measure (FAAM) when a region-specific measure will inform care.
• Perceived ankle instability: Cumberland Ankle Instability Tool (CAIT) when recurrent giving way or instability is a concern.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful.

Les signaux d'alerte orange indiquent qu'un problème de santé mentale ou de toxicomanie peut nécessiter une évaluation d'urgence ou rapide, voire une prise en charge partagée, et peut influencer la prise en charge musculo-squelettique. Ce n'est pas un diagnostic. En cas d'inquiétude, posez des questions directes et respectueuses en tenant compte de la sécurité immédiate, de la gravité du problème, de tout changement par rapport au fonctionnement quotidien habituel et du contexte. Les facteurs psychosociaux susceptibles d’affecter le rétablissement, mais ne nécessitant pas d’évaluation médicale ou psychiatrique distincte, sont abordés sous la rubrique « Signaux d’alerte jaune ».

ACTION : Organisez immédiatement une évaluation d'urgence en cas de danger immédiat ou de besoin médical urgent :

• Suicide, automutilation ou violence envers autrui : intention ou plan actuel, tentative récente, incapacité à rester en sécurité ou comportement suggérant un risque immédiat de préjudice grave.
• Changement grave de l'état mental : agitation extrême, confusion, désorganisation, psychose ou manie possible avec altération du jugement ou comportement dangereux, ou incapacité à satisfaire les besoins fondamentaux lorsque cela crée un danger immédiat.
• Urgence médicale ou liée à la consommation de substances : Suspicion de surdosage, intoxication grave, sevrage dangereux, délire ou autre changement soudain nécessitant des soins médicaux urgents.

En cas de danger immédiat, ne laissez pas la personne seule pendant que les secours sont organisés. Suivez les procédures d'urgence locales et composez le 911 en cas de danger immédiat ou d'urgence médicale. Si la personne a des pensées suicidaires, téléphonez ou envoyez un SMS. 9-8-8 : Ligne d’assistance en cas de crise suicidaire avec eux ou les aider à le faire.

En cas de violence, d'abus ou d'exploitation avérés ou soupçonnés, assurez immédiatement la sécurité des personnes concernées et respectez les procédures de sécurité et de signalement applicables.

ACTION : Organisez rapidement une évaluation médicale ou psychiatrique si :

• Pensées suicidaires ou d'automutilation : Des pensées sans danger immédiat.
• Symptômes ou effets importants : symptômes graves, persistants ou s'aggravant de dépression, d'anxiété, de traumatisme, de psychose ou de manie possible, de troubles alimentaires ou de consommation de substances qui affectent considérablement la vie quotidienne, la prise de décision ou la participation en toute sécurité aux soins.
• Autres motifs d’évaluation : un changement marqué par rapport au comportement ou au fonctionnement habituel ; une inquiétude concernant les effets des médicaments ou des substances ; une présentation qui dépasse les compétences du clinicien ; ou une demande d'aide.

Informer le patient des personnes à contacter, du délai de contact et de la marche à suivre en cas d'aggravation de son état. S'assurer que le patient a bien pris contact avec le service lorsque cela est cliniquement nécessaire.

ACTION : Adapter et coordonner les soins musculosquelettiques :

• Soins en toute sécurité : Les soins peuvent se poursuivre lorsqu'ils sont sécuritaires et acceptables et ne retardent pas l'évaluation nécessaire. Adaptez la communication, l'examen et les soins ; obtenir un consentement continu ; et coordonnez-vous avec les autres professionnels de la santé avec la permission du patient.
• Poursuivre l'évaluation musculosquelettique : Ne présumez pas qu'un problème de santé mentale ou de toxicomanie explique les symptômes musculo-squelettiques. Continuez à considérer les causes physiques et à tenir compte du récit du patient.
• Questionnaires: Ils peuvent soutenir la discussion et le suivi, mais ne permettent pas d’établir un diagnostic et ne remplacent ni les questions directes, ni le jugement clinique, ni les mesures à prendre.
• Soutien acceptable : Demandez à la personne quel type d’aide lui convient et si le soutien linguistique, culturel, familial, communautaire ou autre est important pour elle.

ACTION : Documentation et suivi :

Consignez la préoccupation, les questions pertinentes et les réponses de la personne, la décision relative à la sécurité et les raisons qui la justifient, les mesures prises, les conseils donnés et les références effectuées, les communications et le consentement, le suivi prévu ainsi que toute préoccupation non résolue. Respectez les exigences applicables en matière de confidentialité, de sécurité et de signalement.

Pour obtenir des renseignements sur les services provinciaux, territoriaux et nationaux, consultez : Soutien en santé mentale : obtenir de l’aide (Agence de la santé publique du Canada, 2026).

Les signaux d’alerte psychosociaux (drapeaux jaunes) sont des facteurs personnels, sociaux, professionnels, scolaires, liés aux soins de santé, environnementaux ou structurels qui peuvent influencer les symptômes, le fonctionnement, la participation aux activités ou la réponse aux soins. Ils sont liés au contexte et ne constituent ni des diagnostics ni des prédictions certaines. Ils ne signifient pas que les symptômes sont d’origine psychologique. Ils permettent d’adapter la prise en charge et ne nécessitent pas, à eux seuls, une orientation urgente vers un autre professionnel de la santé. Explorez ces facteurs par la discussion et le suivi continu des résultats, en tenant compte des priorités, des forces et de la situation de la personne. Il n’est pas nécessaire d’utiliser un score distinct pour les signaux d’alerte psychosociaux (drapeaux jaunes). Les nouveaux signes ou l’aggravation de signes d’une maladie physique grave doivent être traités selon la procédure relative aux signes d’alerte (drapeaux rouges). Les préoccupations liées à la santé mentale ou à la consommation de substances qui nécessitent une évaluation distincte, ainsi que toute préoccupation immédiate concernant la sécurité, doivent être traitées selon la procédure relative aux signaux d’alerte psychosociaux urgents (drapeaux orange) et aux protocoles d’urgence ou de protection applicables.

Explorez les facteurs pertinents :

• Compréhension, attentes et expériences en matière de soins de santé : Préoccupations liées aux blessures ou aux dommages, incertitude, attentes quant au rétablissement, confiance en ses capacités, conseils contradictoires, expériences antérieures de banalisation des symptômes ou de préjudices subis, et confiance envers les soins reçus.
• Réactions aux symptômes et à l’activité : Inquiétude, peur, évitement, alternance entre périodes d’activité excessive et périodes de repos prolongées, difficulté à gérer le rythme des activités, stratégies d’adaptation, sommeil, confiance en sa capacité à gérer ses symptômes et reprise des activités significatives.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change safety, the working diagnosis, care or referral. Adapt timing, positioning, pace and loading to symptom irritability, comfort, consent and abilities.

• Ongoing consent and comfort: explain each step, provide choices, ask permission before touch or exposure, and stop or modify the examination when requested.
  
• Immediate safety and bony assessment: inspect skin and wounds; assess colour, temperature, pulses, capillary refill, sensation and motor function when trauma or neurovascular concern is present; palpate the malleoli, navicular, base of the fifth metatarsal, talus, calcaneus and proximal fibula as indicated; and apply the Ottawa Ankle Rules only when appropriate.
  
• Observation, gait and swelling: compare sides for swelling, bruising, deformity, guarding, antalgic gait, weight-bearing tolerance, footwear or support use and functional movement. Quantify swelling when it will guide progression (Delahunt et al. 2018).
  
• Movement and range of motion: assess active and passive dorsiflexion, plantar flexion, inversion and eversion as tolerated; include a weight-bearing dorsiflexion measure when useful; record pain, apprehension, restriction and movement quality (Delahunt et al. 2018).
  
• Palpation and tissue assessment: examine the lateral and medial ligaments, syndesmosis, Achilles and peroneal tendons, ankle joint line and relevant foot and lower-leg structures. Local tenderness helps shape the differential but does not establish severity or stability alone.
  
• Ligament and syndesmosis tests: use anterior drawer, talar tilt and condition-relevant syndesmosis tests when pain, swelling and guarding allow meaningful interpretation. Cluster findings; no single test confirms the complete injury pattern or syndesmotic stability (Delahunt et al. 2018; Netterström-Wedin and Bleakley 2021).
  
• Force et contrôle du moteur : assess ankle and foot strength, endurance and power as tolerated, including plantar flexors and evertors; add hip or lower-limb assessment when it may change rehabilitation (Martin et al. 2021).
  
• Sensorimotor and balance assessment: select static and dynamic balance or proprioceptive tasks that are safe, repeatable and relevant to the patient’s goals (Delahunt et al. 2018).
  
• Functional performance: progress from gait, stairs and single-leg stance to calf raises, hopping, jumping, landing, agility, work or sport tasks only when clinically appropriate. Record pain, quality, confidence and response (Delahunt et al. 2018).
  
• Regional and differential examination: examine the foot, Achilles tendon, calf, proximal fibula, knee, neurological or vascular system, or another region when the history or initial findings indicate.
  
• Imagerie : not routine for a presentation that fits an uncomplicated ankle sprain and has a negative, applicable Ottawa rule. Arrange or coordinate imaging when fracture, syndesmotic instability, osteochondral or tendon injury or another diagnosis is suspected, or when persistent symptoms make the result likely to change care. A negative Ottawa rule does not evaluate every soft-tissue injury (American College of Radiology 2019; American College of Radiology 2020).
  
• Reassessment: repeat the findings and functional tasks needed to track recovery, review the clinical impression, detect adverse effects and decide whether further assessment or referral is appropriate.

Use these as working clinical descriptions rather than definitive tissue diagnoses. They can overlap or change as pain, swelling and function evolve (Martin et al. 2021; Delahunt et al. 2018).

• Recent lateral ankle sprain: a twisting injury with lateral pain or tenderness, swelling or bruising, painful or limited weight bearing and reduced ankle motion, strength, balance or confidence. Describe the current impairments and activity limits rather than relying on a grade label alone.
  
• Suspected syndesmotic, medial or other non-lateral ligament injury: pain above the ankle mortise or a non-inversion injury pattern, with relevant tenderness and a cluster of provocative findings. Clinical tests do not by themselves establish stability. Determine or coordinate assessment of stability and use presentation-specific evidence; follow Red Flags and referral pathways when indicated (Martin et al. 2021; Netterström-Wedin and Bleakley 2021).
  
• Recurrent sprain or chronic ankle instability: repeated sprains or episodes of giving way, perceived instability and persistent pain, swelling, stiffness or participation limits after a previous lateral ankle sprain. Common modifiable findings can include reduced dorsiflexion, strength, balance, sensorimotor control or confidence (Martin et al. 2021).
  
• Alternative or overlapping presentation: findings may point to fracture, Achilles or peroneal tendon injury, osteochondral injury, impingement, nerve involvement, inflammatory or infectious disease, referred pain or another foot, ankle or lower-leg condition. Refer or co-manage when assessment or care is needed beyond the clinician’s role.

Develop care with the patient. Base choices on safety, the working presentation, goals, preferences, culture, age, other health conditions, activity demands, access and response. Use adaptable options and repeat meaningful outcomes to guide change. The intervention evidence below applies to recent lateral ankle sprain, persistent symptoms after a lateral ankle sprain, recurrent lateral ankle sprain and chronic ankle instability; it does not automatically apply to suspected syndesmotic, medial or other non-lateral ligament injuries (Martin et al. 2021).

Éducation, autogestion et participation aux activités

• Lateral ankle sprain or chronic ankle instability — education: explanation of the injury, important uncertainty, the expected variable course, safe loading, symptom response, the reassessment plan and changes that need earlier care (Martin et al. 2021).
• Participation: continued or gradually resumed daily activity, work, school, caregiving, recreation and community participation, with temporary pacing, task modification, footwear or equipment changes and accommodations when useful and feasible.

Protection et mise en charge optimale

• Recent lateral ankle sprain — protection and loading: progressive weight bearing and early functional loading with a brace, tape or gait aid matched to injury severity and symptoms; for a more severe lateral sprain, brief immobilization before loading progresses (Martin et al. 2021).

Activité physique et exercices

• Recent lateral ankle sprain or chronic ankle instability — exercise: protected range of motion; progressive calf and ankle strength and endurance; neuromuscular and proprioceptive training; balance; gait; and relevant functional tasks, progressed to symptoms, goals, capacity and response (Martin et al. 2021; Wagemans et al. 2022).
• Return to activity after lateral ankle sprain: task-specific exposure and repeated functional assessment. For athletes after an acute lateral ankle sprain, PAASS covers pain, ankle impairments, athlete perception and readiness, sensorimotor control, and sport or functional performance; it does not set a universal clearance threshold (Smith et al. 2021).
• Recurrent lateral ankle sprain or chronic ankle instability — recurrence prevention: balance or proprioceptive training and external support during higher-risk activity; a brace or tape is not stand-alone rehabilitation for chronic ankle instability (Martin et al. 2021; Wagemans et al. 2022).

Thérapies manuelles et interventions visant à soulager les symptômes

• Lateral ankle sprain or chronic ankle instability — hands-on care: soft-tissue techniques and pain-free ankle or foot mobilization paired with exercise for short-term goals such as comfortable motion, gait or balance; not as a stand-alone strategy (Martin et al. 2021; de Ruvo et al. 2022).
• Recent lateral ankle sprain — symptom relief: intermittent cold, compression, elevation or comfortable support; protect skin and circulation when sensation or vascular health is impaired, and do not substitute symptom relief for progressive activity (Martin et al. 2021).
• Culturally grounded, traditional, spiritual or community-based approaches identified by the patient can be integrated when they are safe, acceptable and within scope, with coordination across practitioners when needed.

Soutien psychologique, social et interdisciplinaire

• When fear of reinjury, low confidence, distress, competing demands or access barriers affect recovery, use supportive communication and graded exposure within competence, adapt the plan and connect the patient with appropriate psychological, occupational, sport, medical, social or community support.
• Coordinated assessment can support persistent instability, complex comorbidity, substantial participation restriction, uncertainty about another injury or return-to-work or return-to-sport decisions beyond one clinician’s role.

Médicament

• Medication choices can be coordinated with an authorized prescriber or pharmacist. Review current use, intended benefit, contraindications, interactions and adverse effects, and keep medication decisions connected to functioning and the overall plan.

Suivi et réévaluation

• Agree on a reassessment point based on symptom course, safety, goals, the options being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review pain, swelling, ankle motion, strength, balance, gait, functioning, participation, confidence, benefits, adverse effects, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the working presentation, differential diagnosis, barriers, imaging, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Évolution attendue : for adolescents and adults with a lateral ankle sprain, pain and activity often improve over days to weeks, but the course varies with the injury and the person. Recurrent sprain, giving way or other symptoms can persist at 12 months, so no universal return-to-activity timeline applies (Martin et al. 2021; Michels et al. 2022).
  
• Facteurs associés à une évolution moins favorable : higher initial pain or swelling, restricted motion, limited weight bearing, a more severe injury, a non-inversion mechanism and lower self-rated recovery have been linked to slower recovery in some studies, but the evidence does not support certain individual prediction. Persistent perceived instability is associated with recurrent sprain (Thompson et al. 2017; Kawabata et al. 2023).
  
• Facteurs pouvant favoriser le rétablissement : progressive loading, exercise that addresses identified deficits, balance or proprioceptive training, external support for higher-risk activity, adequate functional preparation, confidence, feasible accommodations and access to care may support recovery and reduce reinjury. These are care considerations, not guarantees (Martin et al. 2021; Wagemans et al. 2022).
  
• Discussion du pronostic : describe uncertainty in plain language, ask what the patient wants to know, and update the prognosis using the patient’s goals, repeated outcomes, confidence and response over time rather than treating a grade, risk factor or screening score as a fixed prediction.