Does she need crutches for this ankle sprain?

Management of Ankle Sprain with Soft Tissue Swelling and Joint Effusion

Crutches are recommended for this ankle sprain to reduce weight-bearing on the affected limb, decrease pain, promote faster healing, and prevent complications.

Assessment of the Injury

The X-ray findings show:

• Soft tissue swelling around the left ankle
• Ankle joint effusion
• No acute fracture
• Intact ankle mortise

This presentation is consistent with an ankle sprain with significant soft tissue injury, despite the absence of fracture.

Rationale for Crutch Use

The decision to use crutches is based on several key factors:

• Pain and Swelling Management: Partial weight-bearing with crutches helps reduce pressure on the affected limb, which can significantly decrease pain and prevent exacerbation of swelling 1

• Healing Time: Evidence suggests that patients who comply with partial weight-bearing instructions using crutches experience shorter healing times (approximately 34 days faster) compared to those who don't comply 2

• Prevention of Complications: Continued full weight-bearing on an injured ankle can lead to:

  • Prolonged recovery time
  • Increased risk of re-injury
  • Development of chronic ankle instability
  • Potential for long-term joint damage 1, 3

Recommended Protocol

1. Initial Management (First 72 hours):

   • PRICE protocol (Protection, Rest, Ice, Compression, Elevation)
   • Partial weight-bearing with bilateral crutches
   • Ice application for 15-20 minutes, 3-4 times daily
   • Compression wrap to control swelling

2. Weight-bearing Status:

   • Begin with partial weight-bearing using crutches
   • Progress to full weight-bearing as pain and swelling decrease
   • Typically continue crutch use for 5-10 days depending on symptom improvement

3. Supportive Devices:

   • Semi-rigid ankle support or elastic bandage in addition to crutches
   • Consider a removable walker if pain is severe 1

Early Rehabilitation While Using Crutches

Even while using crutches, early mobilization is important:

• Begin gentle ankle range of motion exercises within 48-72 hours
• Start non-weight-bearing strengthening exercises
• Progress to partial weight-bearing exercises as tolerated

When to Discontinue Crutches

Crutches can be discontinued when:

• Patient can walk without significant pain or limping
• Swelling has significantly decreased
• Patient demonstrates adequate balance and proprioception
• Usually within 7-14 days for moderate sprains

Monitoring for Complications

While using crutches, monitor for:

• Proper crutch technique to avoid secondary injuries
• Skin irritation under the arms
• Adequate progress in pain and swelling reduction

Cautions and Contraindications

• Avoid complete non-weight-bearing as it may delay recovery 1, 4
• Ensure crutches are properly fitted to prevent secondary injuries
• If pain persists beyond 2-3 weeks despite appropriate management, consider further evaluation for occult injuries

Early mobilization with protected weight-bearing using crutches has been shown to allow earlier return to work and normal activities compared to complete immobilization 4, 5, making it the preferred approach for managing this ankle sprain with significant soft tissue swelling and joint effusion.