From the Guidelines
To assess a sprained ankle, a delayed physical examination 4-5 days post-trauma is the most reliable method to determine the severity of ligament damage, as stated in the 2018 guideline update by the British Journal of Sports Medicine 1. When evaluating a sprained ankle, it is essential to consider the following key points:
- Check for pain, swelling, bruising, and difficulty bearing weight on the affected foot
- Apply the RICE protocol immediately: Rest the ankle, Ice it for 15-20 minutes every 2-3 hours, Compress with an elastic bandage, and Elevate the foot above heart level
- Use the Ottawa Ankle Rules to determine if an X-ray is needed: inability to bear weight for four steps immediately after injury or tenderness at specific points of the ankle (posterior edge of lateral or medial malleolus)
- Classify sprains by severity: Grade I (mild stretching of ligaments), Grade II (partial tear with moderate pain and swelling), and Grade III (complete tear with severe pain, swelling, and instability) The most recent and highest quality study, published in 2018 in the British Journal of Sports Medicine, suggests that functional treatment is the clinically preferred treatment strategy for ankle sprains, with a focus on early weight-bearing and active exercise 1. In terms of treatment, the following approaches can be considered:
- Functional treatment with early weight-bearing and active exercise
- Use of a semirigid brace for protection and to facilitate return to work
- Application of ice and nonsteroidal anti-inflammatory drugs to control pain and swelling, as suggested by the 2006 study in the American Family Physician 1 It is crucial to seek medical attention immediately if the patient cannot bear weight, has severe pain or swelling, feels numbness or tingling, or the ankle looks deformed. Most mild to moderate sprains can be managed at home with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours), but severe sprains may require professional evaluation and treatment.
From the Research
Assessment of a Sprained Ankle
To assess for a sprained ankle, a detailed examination focusing on physical examination techniques is crucial 2. This is because other injuries may mimic ankle sprains, and a hands-on grading of ankle sprains dictates treatment and forecasts recovery time.
Key Components of Assessment
- A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription 3
- The combination of available information such as mechanism of injury, all signs and symptoms, and changes in gait, is key to a conclusive and correct diagnosis 4
- Clinical red flags should be discussed and considered during the assessment process 5
Special Tests for Ankle Examination
- Commonly used special tests for diagnosing injury to the ligaments of the ankle complex should be identified and described 4
- The distinguishing characteristics and limitations of each test should be presented, and the current evidence for the clinical use of each test should be discussed 4
- Clinicians should be aware of the severely limited evidence supporting the use of many commonly used special tests 4
Note: Study 6 is not relevant to the assessment of a sprained ankle.