From the Guidelines
The initial care for a severe ankle sprain should follow the RICE protocol and functional treatment with exercise and functional support, such as a brace or tape, is preferred over immobilization. The healing timeline typically spans 4-6 weeks for moderate to severe sprains, with the first week focused on controlling swelling and pain, weeks 2-3 on gradually increasing weight-bearing with possible use of a walking boot or crutches, and weeks 4-6 on strengthening exercises and return to normal activities 1.
Initial Care and Healing Timeline
- Rest the ankle by avoiding weight-bearing for 24-48 hours
- Ice the area for 15-20 minutes every 2-3 hours during the first 48-72 hours
- Compress with an elastic bandage to reduce swelling
- Elevate the ankle above heart level whenever possible
- Use of functional support for 4–6 weeks is preferred over immobilisation, with an ankle brace showing the greatest effects compared to other types of functional support 1
- Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) can help manage pain and reduce inflammation
Follow-up and Prognosis
- After the initial 48-72 hours of protection, begin gentle range-of-motion exercises as tolerated
- Physical therapy is often beneficial to restore full function and prevent re-injury
- A higher physical workload, increased BMI, and greater body height may be associated with an increased risk of recurrent sprains and ankle instability 1
- Adequate attention should be directed towards the patient’s current level of pain, their workload, and level of sports participation to address potential negative influences on recovery and increase the risk of future injury recurrence 1
From the Research
Initial Care for Severe Ankle Sprain
- The initial care for a severe ankle sprain typically involves the RICE protocol: rest, ice, compression, and elevation 2, 3.
- Pain reduction is often managed with nonsteroidal anti-inflammatory drugs (NSAID) or paracetamol 4.
- In some cases, casting and orthotics may be necessary to facilitate healing 2, 5.
Healing Timeline
- The healing timeline for a severe ankle sprain can vary depending on the severity of the injury.
- Generally, patients can expect to follow a 6-week guided rehabilitation program 3.
- Athletes with moderate to severe lateral ankle ligament sprains may need to wear a semirigid or rigid ankle orthosis for at least 6 months following injury 3.
Follow-up Care
- Follow-up care is crucial to ensure proper healing and prevent further complications.
- Patients should be monitored for residual symptoms, such as pain and instability, and undergo regular assessments to determine the effectiveness of treatment 6.
- Early mobilization has been shown to be effective in allowing earlier return to work and may be more comfortable for patients 6.