What is the initial management for a patient presenting with lateral ankle hyperaesthesia?

Management of Lateral Ankle Hyperaesthesia

For patients presenting with lateral ankle hyperaesthesia, the initial management should include functional support with an ankle brace, early exercise therapy, and NSAIDs for pain control rather than immobilization or RICE protocol. 1

Diagnostic Assessment

• Perform delayed physical examination (4-5 days post-trauma) to accurately assess severity of ligament damage 1
• Rule out fractures using Ottawa Ankle Rules if severe sprain is suspected 1
• Assess for modifiable risk factors that may contribute to symptoms (BMI, activity level, sport participation) 1
• Evaluate for signs of neurologic involvement through sensory testing of the lateral ankle 2

Initial Treatment Algorithm

1. Functional Support

   • Apply ankle brace (preferred over tape or other supports) for 4-6 weeks 1
   • Avoid immobilization as it leads to less optimal outcomes compared to functional support 1
   • If immobilization is needed for severe pain/swelling, limit to maximum of 10 days 1

2. Pain Management

   • NSAIDs for pain and swelling reduction (with caution as they may suppress natural healing) 1, 2
   • Topical NSAIDs may be considered for localized relief with fewer systemic side effects 2
   • Paracetamol (acetaminophen) is equally effective as NSAIDs for pain control 1

3. Exercise Therapy

   • Begin exercise therapy as soon as possible to recover joint functionality 1
   • Focus on neuromuscular and proprioceptive exercises 1
   • Progress from isometric to dynamic exercises as tolerated 2
   • Include single-leg balance exercises to improve proprioception 2, 3

Exercise Progression

• Initial Phase (0-2 weeks)

  • Ankle range of motion exercises
  • Isometric strengthening
  • Light weight-bearing as tolerated

• Intermediate Phase (2-4 weeks)

  • Progress to dynamic strengthening exercises
  • Single-leg balance exercises
  • Proprioceptive training on stable surfaces 3

• Advanced Phase (4-6 weeks)

  • Progress to unstable surfaces for balance training
  • Sport-specific exercises
  • Gradual return to activities with no more than 10% increase per week 2

Manual Therapy Considerations

• Manual joint mobilization can provide short-term increases in ankle dorsiflexion range of motion 1
• Most effective when combined with exercise therapy rather than used alone 1
• Can help decrease pain and improve functional outcomes 1

Monitoring and Follow-up

• Assess progress at 2-3 weeks; if no improvement, consider:
  • Customized orthotic device
  • Night splinting
  • Reassessment of diagnosis 1
• Monitor for signs of chronic ankle instability (recurrent sprains, persistent instability) 1
• Evaluate proprioception and kinesthesia as deficits may increase risk of future sprains 3

Common Pitfalls and Caveats

• Avoid RICE protocol (Rest, Ice, Compression, Elevation) as it is not advised as a treatment modality after lateral ankle sprain 1
• Lateral ankle hyperaesthesia may indicate nerve involvement requiring specialized assessment 1
• Altered kinesthesia and joint position sense can lead to increased risk of sustaining lateral ankle sprains 3
• Deep oscillation therapy shows inconclusive evidence for reducing pain and swelling beyond standard care 4
• Neurocryostimulation is no more effective than traditional ice application for improving functional recovery 5

When to Consider Referral

• No improvement after 6-8 weeks of conservative treatment 1
• Suspected nerve entrapment or irritation 1
• Signs of chronic ankle instability developing 6
• Need for diagnostic studies such as EMG, nerve conduction studies, or MRI 1

By following this evidence-based approach focusing on functional support, early exercise therapy, and appropriate pain management, most patients with lateral ankle hyperaesthesia should experience significant improvement in symptoms and function.