Management and treatment of ankle sprain
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:
- 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.
- 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.
Do you have more questions?Â
What are the long-term consequences of recurrent ankle sprains?
Recurrent ankle sprains can lead to chronic instability, joint damage, and increased risk of osteoarthritis in the affected ankle.
Are there any risk factors that predispose individuals to ankle sprains?
Yes, risk factors for ankle sprains include previous history of ankle injury, inadequate footwear, participation in high-impact sports, and environmental factors such as uneven terrain.
Can ankle sprains occur without a specific traumatic event?
Yes, ankle sprains can occur without a specific traumatic event, such as during repetitive activities or sudden changes in direction.
How does the R.I.C.E. (Rest, Ice, Compression, Elevation) protocol help in the management of ankle sprains?
The R.I.C.E. protocol helps reduce pain, swelling, and inflammation, promotes healing, and facilitates early recovery following an ankle sprain.
: What types of exercises are recommended for rehabilitation after an ankle sprain?
Rehabilitation exercises for ankle sprains typically include range of motion exercises, strengthening exercises, balance and proprioception training, and gradual return to functional activities.
How soon after an ankle sprain can weight-bearing activities be resumed?
The timing for resuming weight-bearing activities after an ankle sprain depends on the severity of the injury and individual factors, but partial weight-bearing may be initiated as tolerated in mild to moderate sprains.
Is immobilization necessary for all ankle sprains?
Immobilization may be necessary for severe ankle sprains or those associated with significant ligament damage to promote healing and prevent further injury.
Can ankle braces or supports be used to prevent recurrent ankle sprains?
Yes, ankle braces or supports may help prevent recurrent ankle sprains by providing stability, reducing excessive movement, and supporting the injured ligaments during physical activity.
How does physical therapy contribute to the management of ankle sprains?
Physical therapy plays a key role in the management of ankle sprains by promoting tissue healing, restoring joint mobility and strength, improving balance and proprioception, and facilitating safe return to activity.
Are corticosteroid injections recommended for the treatment of ankle sprains?
Corticosteroid injections may be considered for severe ankle sprains with significant pain and inflammation, but their use is generally limited due to potential adverse effects and risk of tendon weakening.
What are the potential complications of untreated or poorly managed ankle sprains?
Potential complications of untreated or poorly managed ankle sprains include chronic pain, instability, recurrent injuries, joint stiffness, and long-term functional limitations.
Can ankle sprains lead to other injuries in the foot or lower extremity?
Yes, ankle sprains can lead to secondary injuries such as peroneal tendon injuries, ankle impingement, cartilage damage, or stress fractures in the foot or lower leg.
How does the timing of treatment initiation affect the outcomes of ankle sprains?
Early initiation of appropriate treatment, including rest, ice, compression, elevation, and rehabilitation, can lead to faster recovery and better long-term outcomes for ankle sprains.
Are there any special considerations for managing ankle sprains in children or adolescents?
Yes, special considerations for managing ankle sprains in children or adolescents may include growth plate injuries, age-appropriate rehabilitation exercises, and gradual return to sports activities to prevent re-injury.
What are the criteria for determining when it is safe to return to sports or physical activities after an ankle sprain?
The criteria for safe return to sports or physical activities after an ankle sprain include resolution of pain and swelling, restoration of range of motion and strength, functional stability, and successful completion of rehabilitation protocols.
Are there any specific guidelines for preventing ankle sprains in athletes or individuals participating in high-risk activities?
Yes, specific guidelines for preventing ankle sprains may include wearing appropriate footwear, performing ankle-strengthening exercises, using protective bracing or taping, and avoiding hazardous playing surfaces.
Can ankle sprains be prevented through pre-season conditioning programs or ankle injury prevention protocols?
Yes, pre-season conditioning programs and ankle injury prevention protocols that focus on strengthening, flexibility, proprioception, and proper biomechanics can help reduce the risk of ankle sprains in athletes and active individuals.
How effective are ankle braces or prophylactic taping in preventing initial or recurrent ankle sprains?
Ankle braces or prophylactic taping may reduce the risk of initial or recurrent ankle sprains in individuals with a history of ankle instability or those participating in high-risk activities, but their effectiveness may vary depending on factors such as compliance and fit.
