What are the management options for ankle pain?

Management Options for Ankle Pain

Functional treatment with supervised exercises focusing on proprioception, strength, coordination, and function is the most effective approach for managing ankle pain, particularly for ankle sprains. 1

Initial Management

• RICE (Rest, Ice, Compression, Elevation) alone has no positive influence on pain, swelling, or patient function in acute ankle sprains 1
• Cryotherapy combined with exercise therapy is more effective for reducing swelling than cryotherapy alone 2
• NSAIDs are effective for short-term pain relief (<14 days) without significantly increasing adverse events compared to placebo 1
• Oral or topical NSAIDs should be used at the lowest effective dose for the shortest duration to minimize side effects 3
• For ibuprofen, 400mg every 4-6 hours as needed is recommended for pain relief 3
• Paracetamol (acetaminophen) is equally effective as NSAIDs for pain, swelling, and range of motion 1
• A short period (<10 days) of immobilization with a plaster cast or rigid support can help decrease pain and edema in acute lateral ligament injuries 1

Functional Support

• Functional support for 4-6 weeks is preferred over immobilization 1
• Ankle braces show greater effects compared to other types of functional support 1
• A semirigid brace is the most cost-effective option compared to taping 1
• Functional treatment allows patients to return to sports approximately 4.6 days sooner than immobilization 4

Exercise Therapy

• Supervised exercises focusing on proprioception, strength, coordination, and function lead to faster return to sport and are strongly recommended 1
• Exercise therapy initiated early following an acute ankle sprain can reduce the prevalence of recurrent injuries and functional ankle instability 1
• Exercise therapy has the strongest evidence (level 1) for effectiveness in ankle sprain rehabilitation 2
• Manual mobilization is advised only in combination with other treatment modalities to enhance treatment effect 2

Management of Chronic Ankle Pain

• Chronic ankle pain is often due to sequelae from lateral ankle sprains 5
• Other causes include peroneal tendinopathy, osteochondral injury, lateral ankle impingement, sinus tarsi syndrome, and cuboid syndrome 5
• Early functional bracing, physical therapy for strengthening, and proprioceptive exercises are preferred treatments for most patients with chronic ankle pain 5
• Inadequate rehabilitation, impingement, occult lesions, peroneal tendon injury, syndesmosis injury, or lateral instability can cause persistent pain after ankle sprain 6

Prevention of Recurrence

• Functional support (bracing) is effective in preventing recurrent ankle injuries 4
• Neuromuscular training has shown significant preventive effects for recurrent ankle sprains 4
• Exercise therapy should be incorporated into regular training activities as much as possible for those with recurrent ankle sprains 2

Common Pitfalls and Considerations

• Inadequate treatment can lead to chronic problems such as decreased range of motion, pain, and joint instability 2
• NSAIDs may delay the natural healing process as inflammation is a necessary component of tissue recovery 1
• Clinical assessment of ligament damage is optimized if delayed for 4-5 days post-injury when swelling has decreased 2
• Opioid analgesics, while equally effective for pain relief, lead to significantly more side effects than NSAIDs 1