Crepe Bandage Size Determination for Ankle Sprains
Direct Answer
There is no evidence-based recommendation for a specific width of crepe bandage for ankle sprains, and current guidelines indicate insufficient evidence to recommend compression bandaging at all for acute ankle injuries. 1
Evidence Summary and Clinical Reasoning
Guideline Position on Compression Bandaging
The 2020 International Consensus on First Aid Science explicitly states there is insufficient evidence to recommend for or against the application of a compression bandage for an acute closed extremity joint injury, including ankle sprains. 1 This recommendation remains unchanged from 2010 and was reaffirmed in 2022. 1
The evidence review found:
- No reduction in pain with compression bandages compared to no compression, non-compressive bandages, or braces (low-certainty evidence from 2 RCTs and 3 non-randomized trials) 1
- No reduction in swelling/edema (very low-certainty evidence from 3 RCTs and 1 non-randomized trial) 1
- No improvement in range of motion or recovery time compared to ankle braces (low to very low-certainty evidence from 5 RCTs) 1
Superior Treatment Alternatives
Lace-up or semi-rigid ankle braces are strongly preferred over elastic/crepe bandages for ankle sprain management. 2, 3, 4, 5
The evidence demonstrates:
- Faster return to sports by 4.6 days with bracing versus immobilization 2
- Faster return to work by 7.1 days with functional bracing 2
- Significantly higher patient satisfaction with semi-rigid braces compared to tape (similar principle applies to elastic bandages) 5
- Lower complication rates (14.6% versus 59.1% skin complications with tape) 5
Clinical Application
If compression bandaging is used despite limited evidence:
For initial emergency department management:
- Apply a double-layer tubular compression bandage (such as Tubigrip) only for the first 5-7 days for comfort 3, 6
- Transition to a lace-up or semi-rigid ankle brace within 48 hours and continue for 4-6 weeks 2
Critical implementation points:
- Ensure circulation is not compromised when applying any compression 2
- Studies did not specify optimal pressure, direction of application, or exact duration, limiting evidence-based guidance 1
- Begin supervised exercise therapy within 48-72 hours regardless of support method used (Level 1 evidence) 2
Common Pitfalls
- Avoid prolonged use of elastic bandages alone as they show no functional benefit and may delay recovery 7, 4
- Do not rely on compression bandaging as primary treatment—it should be part of broader functional rehabilitation 2
- Tubigrip specifically has been shown to have no positive effect on functional recovery and may increase analgesic requirements 7
Practical Recommendation
Rather than focusing on crepe bandage width, immediately transition patients to a lace-up or semi-rigid ankle brace (no specific sizing beyond standard adult/adolescent fit) combined with early weight-bearing and supervised exercise therapy starting within 48-72 hours. 2, 3 This approach has the strongest evidence for improving outcomes including pain, function, and return to activity. 2, 4, 5