What is the likely diagnosis for a patient with acute ankle pain and lateral ankle tenderness after an inversion injury, likely involving the Anterior Talofibular Ligament (ATFL)?

From the Guidelines

The patient should be managed with the RICE protocol, NSAIDs for pain, short-term immobilization, and progressive rehabilitation exercises to reduce morbidity and improve quality of life. The RICE protocol consists of rest, ice, compression, and elevation to reduce pain and swelling [ 1 ]. For pain management, NSAIDs such as ibuprofen 400-600mg three times daily with food for 5-7 days are recommended. Short-term immobilization with an ankle brace or air stirrup for 7-10 days may help protect the injured ligament during early healing. After the acute phase (48-72 hours), the patient should begin gentle range-of-motion exercises and gradually progress to strengthening exercises, including ankle circles, alphabet tracing with the foot, and resistance band exercises.

Weight-bearing should be as tolerated with proper support. If symptoms persist beyond 2 weeks, physical therapy referral is warranted [ 1 ]. The patient should use proper ankle support when returning to skateboarding and follow a gradual progression, starting with basic skills before attempting more complex maneuvers. This comprehensive approach addresses both immediate pain relief and long-term stability, reducing the risk of recurrent sprains which is higher in patients with previous ankle injuries.

Key considerations in management include:

• Early identification and management of prognostic factors for poor outcome, such as high physical workload, young age, and increased BMI [ 1 ]
• Use of functional support devices, such as ankle braces, to prevent recurrent sprains [ 1 ]
• Progressive rehabilitation exercises to improve ankle strength, range of motion, and proprioception [ 1 ]
• Patient education on proper ankle support and gradual return to activities to reduce the risk of recurrent injury [ 1 ].

From the Research

Diagnosis and Treatment

• The patient's symptoms, including acute ankle pain after inversion injury and audible "pop," suggest a likely diagnosis of lateral ankle sprain, most commonly involving the anterior talofibular ligament (ATFL) 2.
• The treatment plan includes RICE protocol (rest, ice, compression, elevation), which is a common approach for managing ankle sprains, although there is insufficient evidence from randomized controlled trials to determine its relative effectiveness 2.
• The use of hydrotherapy with hydrogen-rich water has been compared to the RICE protocol in a randomized non-inferiority pilot trial, and the results suggest that it may be an effective alternative for managing acute ankle sprains 3.

Rehabilitation and Prevention

• Progressive rehabilitation exercises and possible short-term immobilization are recommended to promote healing and prevent further injury.
• Pain management with NSAIDs is also a common approach, although the patient's individual needs and medical history should be taken into account.
• Referral to physical therapy may be considered if symptoms persist beyond 2 weeks.
• Patient education on proper ankle support during activities and gradual return to skateboarding is crucial to prevent recurrence and promote safe return to sports.

Evidence-Based Practice

• The treatment decisions for ankle sprains must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines 2.
• More studies are needed to corroborate the findings on the effectiveness of hydrotherapy with hydrogen-rich water in managing acute ankle sprains 3.