Management and treatment of ankle sprain

Ankle sprains are incredibly common, both among athletes and the general population, often requiring significant medical attention. They result in pain, limited movement, and can lead to various complications like disability and arthritis.

Around 44% of individuals who suffer from a sprained ankle experience lingering issues even a year after the injury. Surprisingly, factors like foot type, joint flexibility, and gender don’t seem to increase the risk of sprains

Ankle sprains make up a considerable portion of emergency room visits and sports injuries, with significant economic costs associated. In the Netherlands alone, they result in thousands of treatments annually, totaling millions in healthcare expenses.

These injuries are particularly prevalent in sports like basketball and soccer, where they account for a substantial portion of all injuries, especially affecting the lateral ligaments of the ankle.

Clinical practice guidelines (CPGs) provide recommendations for the evaluation and treatment of various health conditions. However, there hasn’t been a comprehensive review of CPGs specifically addressing ankle sprains, including the quality of evidence and recommendations.

This study aims to fill that gap by systematically reviewing existing CPGs focused on ankle sprains. It seeks to evaluate their quality, analyze the evidence they’re based on, and summarize their recommendations.

A study was conducted to understand how best to manage and treat ankle sprains, aiming to simplify the existing guidelines for patients like you.

Some guidelines recommend using the Ottawa rules to distinguish between ankle sprains and fractures.

The Ottawa ankle rules are guidelines used by doctors to help determine if an X-ray is needed after an ankle injury. These rules are based on a series of questions and physical exams that assess the severity of the injury and the likelihood of a fracture.

Here’s a simplified explanation of the Ottawa ankle rules:

  1. Pain in specific areas: If you have pain in certain spots around your ankle (like the bone on the inner or outer side), it could indicate a fracture.
  2. Difficulty walking: If you’re unable to bear weight on your ankle and take a few steps without pain, it might suggest a fracture.


When it comes to using supports like braces or tape, recent updates suggest that using a brace for 4 to 6 weeks is better than immobilization or using a bandage. Ankle braces offer more stability compared to tape. This means there’s no need for more research in this area.

Exercise plays a crucial role in recovery. While initially, exercise might not be highly recommended, it becomes more important during recovery. Therapeutic exercises have been recommended across different guidelines to improve ankle function and reduce the risk of future injuries. It’s not clear whether these exercises need to be supervised by a professional, but they’re beneficial nonetheless.

Manual therapy, like massage or manipulation, has shown to be helpful in both short and long-term recovery from ankle sprains. Even a single session can reduce swelling and pain. In the acute phase of the injury, walking or putting weight on the affected ankle is also encouraged for faster recovery.

Cryotherapy (Using Ice): Applying ice during the early stage of ankle sprains significantly reduces pain and swelling compared to pain-relieving drugs. However, it’s not as effective during the recovery phase and should mainly be used for acute sprains to manage pain and swelling.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): These are recommended by several guidelines during the acute phase of ankle sprains as they are safe. However, their long-term use isn’t advised due to potential risks.

Rehabilitation: This is highly recommended in two guidelines, as it greatly improves patients’ recovery for returning to sports. It enhances various aspects like strength, coordination, and overall lower limb function.

Acupuncture: While there’s some uncertainty about its effectiveness, acupuncture is considered a viable option due to its low risk and cost. However, more research is needed to determine its effectiveness compared to traditional treatments.

Immobilization: For severe ankle sprains (Grade III), immobilization for up to 10 days is recommended, but longer periods aren’t advised. After this period, functional treatment should begin.

Surgery: Surgery isn’t typically recommended except for chronic injuries or severe ligament damage, especially in professional athletes where a quicker return to sport is crucial.

Conservative Treatment: This is generally preferred as it avoids invasive procedures and risks of complications.

Other Therapies: Modalities like ultrasound, diathermy, electrotherapy, and laser therapy haven’t shown strong evidence of effectiveness and aren’t recommended for treating ankle sprains.

Opiates: Their recommendation level is low, and further research is needed to determine their efficacy in treating ankle sprains.

After examining the current guidelines on managing ankle sprains, we identified 17 recommendations. Evaluating their quality, evidence levels, and recommendation levels, we found that six recommendations have strong evidence and are highly recommended for ankle sprain treatment: Ottawa rules, manual therapy, cryotherapy, supportive devices, early walking, short-term NSAIDs, and rehabilitation.

Some areas like acupuncture, electroacupuncture, and pharmacopuncture have less evidence but still show promising scientific support, suggesting the need for further research. However, there are areas with insufficient evidence, such as diathermy, laser therapy, electrotherapy, and ultrasound.

A seasoned orthopedic surgeon and foot and ankle specialist, Dr. Mohammad Athar welcomes patients at the offices of Complete Orthopedics in Queens / Long Island. Fellowship trained in both hip and knee reconstruction, Dr. Athar has extensive expertise in both total hip replacements and total knee replacements for arthritis of the hip and knee, respectively. As an orthopedic surgeon, he also performs surgery to treat meniscal tears, cartilage injuries, and fractures. He is certified for robotics assisted hip and knee replacements, and well versed in cutting-edge cartilage replacement techniques.
In addition, Dr. Athar is a fellowship-trained foot and ankle specialist, which has allowed him to accrue a vast experience in foot and ankle surgery, including ankle replacement, new cartilage replacement techniques, and minimally invasive foot surgery. In this role, he performs surgery to treat ankle arthritis, foot deformity, bunions, diabetic foot complications, toe deformity, and fractures of the lower extremities. Dr. Athar is adept at non-surgical treatment of musculoskeletal conditions in the upper and lower extremities such as braces, medication, orthotics, or injections to treat the above-mentioned conditions.