What is the treatment for a right ankle sprain?

Right Ankle Sprain Treatment

Functional rehabilitation with semirigid or lace-up ankle supports is the most effective treatment for ankle sprains, superior to immobilization, and should be implemented after initial PRICE protocol. 1

Initial Assessment and Management

Assessment

• Determine severity using grading system:

  • Grade I: Stretching of ligaments without macroscopic tearing
  • Grade II: Partial tear of ligaments
  • Grade III: Complete tear of ligaments 1

• Apply Ottawa Ankle and Foot Rules to rule out fracture:

  • Bone tenderness at posterior edge/tip of lateral/medial malleolus
  • Inability to bear weight immediately after injury and in emergency department
  • Bone tenderness at base of 5th metatarsal or navicular 1

Immediate Treatment (First 24-72 hours)

1. PRICE Protocol - While traditional, recent evidence questions its effectiveness as a standalone treatment 1:

   • Protection: Protect from further injury
   • Rest: Limited rest (up to 72 hours)
   • Ice: Apply for 15-20 minutes every 2-3 hours
   • Compression: Use elastic bandage or wrap
   • Elevation: Keep ankle elevated above heart level

2. NSAIDs: Provide oral NSAIDs (e.g., ibuprofen, naproxen, diclofenac) for pain control and to reduce swelling. These have been shown to improve pain control, decrease swelling, and speed return to activity 1

Rehabilitation Phase (After 48-72 hours)

Functional Treatment

Implement a three-phase functional rehabilitation program 1:

1. Phase 1 (Days 1-3):

   • Apply semirigid or lace-up ankle support (superior to elastic bandages) 1
   • Begin gentle range-of-motion exercises
   • Gradually increase weight-bearing as tolerated

2. Phase 2 (Days 4-7):

   • Progress to strengthening exercises:
     • Ankle alphabet (trace alphabet with toes)
     • Towel curls (curl towel with toes)
     • Resistance band exercises in all directions

3. Phase 3 (Week 2 onward):

   • Proprioceptive training (balance exercises)
   • Sport-specific exercises
   • Endurance training

Specific Exercise Recommendations

• Ankle disk or wobble board training
• Single-leg balance exercises
• Heel raises and toe raises
• Walking on uneven surfaces

Treatment Based on Severity

Grade I Sprains

• Functional treatment with early weight-bearing
• Semirigid or lace-up ankle support for 1-2 weeks
• Return to activity typically within 1-2 weeks

Grade II Sprains

• Functional treatment with protected weight-bearing
• Semirigid or lace-up ankle support for 2-4 weeks
• Progressive rehabilitation program
• Return to activity typically within 2-6 weeks

Grade III Sprains

• Functional treatment with protected weight-bearing
• Semirigid or lace-up ankle support for 4-6 weeks
• Comprehensive rehabilitation program
• Consider orthopedic referral for severe cases
• Return to activity typically within 6-12 weeks

Prevention of Recurrence

• Continue proprioceptive training after recovery
• Use ankle support during high-risk activities, especially for those with history of sprains 1
• Implement ankle strengthening exercises as part of regular fitness routine

Common Pitfalls to Avoid

1. Over-immobilization: Immobilization is inferior to functional treatment and can lead to joint stiffness, muscle atrophy, and delayed recovery 1

2. Inadequate rehabilitation: Insufficient rehabilitation is a common cause of persistent pain and recurrent sprains 2

3. Missed diagnoses: Be alert for conditions that mimic ankle sprains:

   • Syndesmotic injuries (high ankle sprains)
   • Peroneal tendon injuries
   • Osteochondral lesions
   • Fractures of the lateral process of the talus 2

4. Premature return to full activity: Ensure adequate strength and proprioception before allowing return to sports

5. Relying solely on RICE: Recent evidence suggests RICE alone is not effective; it should be combined with functional rehabilitation 1