From the Guidelines
It is generally not recommended to leave an elastic (ace) bandage on a sprained or fractured ankle overnight, as this can potentially restrict blood flow and lead to complications such as numbness, tingling, increased pain, swelling, or skin discoloration 1. While compression is an important part of the treatment protocol for sprains, it should be balanced against the risk of compromising circulation, especially during periods of inactivity like sleep.
Instead, remove the bandage before sleeping to allow normal circulation during the night, and reapply a properly wrapped elastic bandage in the morning. The bandage should be snug but not tight - you should be able to slip a finger between the bandage and your skin. If a healthcare provider has specifically instructed you to keep the bandage on overnight as part of your treatment plan, follow their guidance. For fractures, always follow the specific instructions provided by your doctor, as immobilization requirements differ from sprains.
The purpose of compression is to reduce swelling by preventing fluid accumulation in the injured area, but this benefit must be balanced against the risk of compromising circulation, especially during periods of inactivity like sleep. According to the 2024 American Heart Association and American Red Cross guidelines for first aid, compression wraps can be useful for promoting comfort after an acute ankle sprain or strain, but application should be performed without compromising circulation 1.
Key considerations for treating ankle sprains include the use of semirigid or lace-up ankle supports as a functional treatment, and graded exercise regimens to help reduce the risk of ankle sprain 1. However, the most recent and highest quality study on this topic is the 2024 guidelines, which emphasize the importance of balancing compression with circulation 1.
In terms of specific treatment recommendations, the guidelines suggest that a person with a painful extremity injury that limits use should avoid activities that cause pain and seek medical attention 1. Cold application, such as with ice and water surrounded by a damp cloth, can be useful for pain and swelling, but should be limited to 20 to 30 minutes per application without direct contact on the skin to avoid cold injury 1.
Overall, the best approach to treating a sprained or fractured ankle is to follow the guidance of a healthcare provider and to prioritize circulation and comfort during the recovery process. Removing the elastic bandage overnight and reapplying it in the morning is a safe and effective way to balance compression with circulation, and can help promote healing and reduce the risk of complications 1.
From the Research
Ankle Sprain Treatment with Ace Bandage
- The use of an ace bandage on a sprained or fractured ankle is a common treatment approach, but its effectiveness and safety for overnight use are not well-established in the provided studies.
- A study from 1991 2 compared the effect of compressing antiembolism stockings versus ace-bandages in treating acute ankle distortions and found no significant difference between the two treatments.
- Another study from 2024 3 investigated the immediate effects of wearing an ankle bandage on fine coordination, proprioception, balance, and gait in the subacute phase of ankle sprains, and found moderate to strong improvements in ankle stability and pain relief while wearing the bandage.
Comparison with Other Treatments
- A 2005 study 4 compared the functional outcome of treating inversion injuries with an elastic support bandage versus an Aircast ankle brace and found that the Aircast ankle brace produced a significant improvement in ankle joint function at both 10 days and one month.
- A systematic review from 2011 5 evaluated the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments, including ankle tape and elastic bandages, and found that ankle brace treatment may be a more cost-effective method.
Clinical Practice Guidelines
- A 2022 systematic review 6 summarized the current clinical practice guidelines on management and treatment of ankle sprains and found that six recommendations, including the use of functional supports, have enough evidence to be applied in clinical practice.
Overnight Use of Ace Bandage
- None of the provided studies directly address the safety and effectiveness of leaving an ace bandage on a sprained or fractured ankle overnight. Therefore, it is unclear whether an ace bandage can be safely left on overnight based on the available evidence.