What is the recommended crepe bandage size for an adult or adolescent patient with an ankle sprain?

Crepe Bandage Size for Ankle Sprain

Direct Answer

There is no specific recommended crepe bandage size for ankle sprains, and current evidence does not support the routine use of compression bandages (including crepe bandages) over more effective alternatives like semi-rigid braces or below-knee casts. 1

Evidence-Based Treatment Hierarchy

What the Guidelines Actually Say

The 2020 International Consensus on First Aid Science states there is insufficient evidence to recommend for or against the application of a compression bandage for acute closed extremity joint injury, as compression bandages showed no benefit for pain reduction, swelling reduction, range of motion, or recovery time compared to no compression or other supports. 1

Superior Alternatives to Compression Bandages

Instead of a crepe bandage, you should use:

• Below-knee cast (first choice): Provides the widest range of clinical benefits at 3 months, with significantly better pain control (FAOS pain difference 5.1; 95% CI 0.3-10.0), improved ankle function, and faster recovery. 2, 3

• Semi-rigid ankle brace (Aircast-type, second choice): Produces significantly higher ankle function scores at both 10 days (mean Karlsson score 50 vs 35, p=0.028) and one month (68 vs 55, p=0.029) compared to elastic bandages. 1, 4, 5

• Lace-up ankle supports: More effective than tape or elastic bandages, resulting in shorter time to return to sports and work. 1, 4

Why Compression Bandages Are Not Recommended

The evidence demonstrates that:

• No pain reduction: Multiple RCTs showed no significant reduction in pain with compression bandages versus no compression (SMD 0.34; 95% CI -0.10 to 0.79, p=0.12). 1

• No swelling reduction: Very low-certainty evidence from 4 studies showed compression bandages did not reduce swelling (SMD 0.54; 95% CI -0.14 to 1.22, p=0.12). 1

• Inferior functional outcomes: Patients treated with elastic bandages had significantly worse ankle function scores compared to those using braces or casts. 2, 3, 5

• Slower return to activity: Elastic bandages resulted in delayed return to work (7.1 days longer) and sports (4.6 days longer) compared to functional supports. 1, 4

Practical Clinical Algorithm

For acute ankle sprains, follow this approach:

1. Apply Ottawa Ankle Rules to determine if radiographs are needed (inability to bear weight, point tenderness over malleoli). 1, 6

2. Choose mechanical support based on severity:

   • Severe sprains: Below-knee cast for 10 days, then transition to brace (most cost-effective at £339 per QALY). 2, 3
   • Moderate sprains: Semi-rigid or lace-up ankle brace for 4-6 weeks. 4, 7
   • Avoid: Tubular compression bandages or crepe bandages as primary treatment. 2, 3

3. Initiate PRICE protocol with the mechanical support:

   • Protection with brace/cast
   • Rest (limited weight-bearing for 3-5 days)
   • Ice (20-30 minutes per application)
   • Compression (via the brace, not elastic bandage)
   • Elevation above heart level 4, 7

4. Start supervised exercise therapy within 48-72 hours, including range of motion, proprioception training, and strengthening exercises (Level 1 evidence for effectiveness). 4, 6, 7

Critical Pitfalls to Avoid

• Do not use elastic/crepe bandages as the primary treatment when braces or casts are available, as this significantly delays recovery without any demonstrated benefit. 1, 2

• Do not immobilize beyond 10 days for severe sprains or beyond what's needed for initial pain control, as prolonged immobilization shows no long-term benefits. 1, 4

• Do not rely on compression alone without functional support and early exercise therapy, as this approach has no evidence for effectiveness. 4

If You Must Use Compression

If circumstances absolutely require using compression bandaging (e.g., resource-limited settings), recognize that:

• Studies did not specify optimal pressure, direction of application, or duration of use. 1
• Class II compression stockings (23-32 mmHg) showed some benefit for return to sports in active patients (p=0.02) but no benefit for general recovery. 8
• Elastic stockings provided better outcomes than Tubigrip at 8 weeks (AOFAS score 99 vs 88, p<0.001). 9

However, even in resource-limited settings, a simple below-knee cast remains superior and more cost-effective than any compression bandage option. 2, 3