What is the treatment for an ankle sprain?

Treatment of Ankle Sprains

The most effective treatment for ankle sprains involves immediate implementation of functional rehabilitation with supervised exercises focusing on proprioception, strength, coordination, and function, along with appropriate supportive devices rather than immobilization. 1

Initial Management (First 48-72 Hours)

• The traditional PRICE protocol (Protection, Rest, Ice, Compression, Elevation) should be implemented immediately after injury, though evidence indicates that RICE alone has no positive influence on pain, swelling, or patient function 1, 2
• Cryotherapy (ice application) combined with exercise therapy shows greater effect on reducing swelling compared to heat application, which should be avoided in acute injuries 1, 3
• NSAIDs may be used in the acute phase to reduce pain and swelling 1, 4
• Functional support, particularly bracing or semirigid ankle supports, is preferred over immobilization and is more effective than tape or elastic bandages 1, 3

Rehabilitation Protocol

• Exercise therapy should begin as soon as possible (within 48-72 hours) after injury to recover joint functionality 1, 3
• Supervised exercises should focus on:
  • Range of motion exercises 3
  • Strengthening exercises 3
  • Proprioception training 1, 3
  • Coordination and functional activities 1
• Manual mobilization is beneficial when combined with other treatment modalities to enhance the treatment effect 1

Support Devices and Return to Activities

• Lace-up or semirigid ankle supports are recommended as they result in shorter time to return to normal activities and less ankle instability 3
• Functional treatment helps patients return to sports 4.6 days sooner and to work 7.1 days sooner than immobilization 1
• A return-to-work schedule should be implemented to minimize work absenteeism 1

Follow-up Care

• Re-examination 3-5 days after injury is crucial for accurate diagnosis and treatment planning, as clinical assessment of ligament damage is optimized when swelling has decreased 1, 3
• For recurrent ankle sprains, exercise therapy should be incorporated into regular training activities 1

Common Pitfalls to Avoid

• Inadequate treatment can lead to chronic problems such as decreased range of motion, pain, joint instability, and chronic ankle instability in up to 20% of cases 1, 3, 5
• Prolonged immobilization should be avoided as it shows no benefits compared to functional treatment 1, 3
• Failure to properly diagnose and treat syndesmotic injuries (high ankle sprains), which require specific management approaches 1, 6
• Overlooking other potential injuries that may mimic ankle sprains, requiring a thorough physical examination 2

When to Consider Advanced Treatment

• Persistent pain lasting 6 or more weeks after a sprain may indicate inadequate rehabilitation, impingement, occult lesions, peroneal tendon or syndesmosis injury, or lateral instability 6
• Patients with chronic ankle instability who fail functional rehabilitation may require surgical intervention, such as Brostrom-Gould anatomic repair 5
• For refractory cases of impingement syndrome, surgery may be recommended 6