Table 1 Section II: clinical vignette

Vignette 1: first episode of acute LAS with negative signs and symptoms for suspecting a bone fracture (negative OAR).

History: A.R. is a 40-year-old woman, working as a post office employee with a passion for gardening. Yesterday she had a first episode of LAS when she put her foot in plantar flexion and inversion while gardening. She managed to go back home limping. The day after the injury, she went to the physiotherapist, walking with the help of two crutches and keeping her foot off the ground.

Physical examination: When asked to put her foot on the ground to try to walk four steps, the patient stated that she was afraid of feeling pain, however she was able to walk throughout the room without limping, but with a pain in the lateral compartment of 4 out of 10 on the VAS (Visual Analogue Scale) pain scale. She has no pain on palpation of the posterior 6 cm of the malleoli, nor the lateral and medial midfoot area. There is mild oedema and haematoma in the anterolateral compartment of the ankle.

Vignette 2: reinjury acute lateral ankle sprain with positive signs and symptoms for suspecting a bone fracture (positive OAR).

History: G.C. is a 20-year-old female basketball player studying at university. Two days ago, during a game, she had an episode of LAS while placing her foot in plantar flexion and inversion when landing from a jump. This is the second episode of a sprained ankle injury, the first occurred three years ago, after which she underwent rehabilitation until she could play again.

This time she had to stop playing immediately during the competition, came out from the basketball field hopping on the opposite foot. She applied ice immediately and the ankle got quickly swollen. She tried to put her foot on the floor and bare weight to walk to the changing room, but the pain was too high (VAS 8/10). Until now she has kept her foot elevated with ice and she never put it down on the floor to walk, but at night her ankle hurts a lot (VAS 8/10). She presented two days after the injury to the physiotherapist for the first visit, walking with two crutches without weight bearing.

Physical examination: when asked to place her foot on the floor to try to walk 4 steps the patient reported 8 out of 10 pain on the VAS (Visual Analogue Scale) pain scale, by palpating the 6 cm posterior to the peroneal malleolus she reported a pain level of 7/10 on the VAS scale.