What is the treatment for ankle swelling when there is no fracture?

Treatment of Ankle Swelling Without Fracture

For ankle swelling without fracture, initiate the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) combined with NSAIDs for pain and swelling control, followed by functional rehabilitation with semirigid or lace-up ankle supports rather than immobilization. 1

Immediate Management (First 72 Hours)

PRICE Protocol

• Protection: Apply semirigid ankle support or lace-up brace (superior to elastic bandages) 1
• Rest: Limit weight-bearing activities for up to 72 hours 1
• Ice: Apply cryotherapy to reduce edema and pain; direct ice application decreases recovery time 1
• Compression: Use compressive device with focal compression for faster functional recovery 1
• Elevation: Keep ankle elevated above heart level 1

Pharmacologic Management

• NSAIDs are recommended to reduce swelling and pain, and may decrease time to return to usual activities 1
• Evidence shows NSAIDs (piroxicam, celecoxib, naproxen) improve pain control, decrease swelling, and enable more rapid return to activity compared to placebo 1
• Important caveat: While NSAIDs reduce pain and swelling, they may suppress natural healing processes, so use judiciously 1

Functional Rehabilitation (After Initial 72 Hours)

Support Devices

• Semirigid or lace-up ankle supports are strongly recommended over elastic bandages for functional treatment 1
• Continue support device use during rehabilitation phase 1

Exercise-Based Treatment

• Functional rehabilitation is preferred over immobilization - immobilization leads to joint stiffness, muscle atrophy, and loss of proprioception 1, 2
• Initiate graded exercise regimens focusing on:
  • Motion restoration 1
  • Strengthening exercises 1
  • Proprioceptive training (ankle disk training) to reduce risk of recurrent sprains 1

Follow-Up Assessment

• Reexamine at 3-5 days post-injury when pain and swelling have improved to better distinguish partial tears from complete ligament ruptures 1
• Excessive swelling and pain can limit accurate examination in first 48 hours 1

Prevention of Recurrence

• Continue using semirigid or lace-up ankle supports, especially if history of recurrent sprains 1
• Implement proprioceptive neuromuscular facilitation exercises or ankle disk training programs 1

Critical Pitfalls to Avoid

• Do not immobilize - functional treatment with early mobilization is superior to immobilization for recovery 1
• Do not use heat in acute phase - not recommended for acute ankle injury 1
• Inadequate treatment leads to chronic problems including decreased range of motion, persistent pain, and joint instability 1