Vuurberg et al 2018

Almost everyone has had an ankle sprain. After reading this blogpost, you will know about the most recent guidelines.

More of a listener/watcher than a reader? Make sure to watch this synopsis video on the topic.

Predisposing Factors

‘Predicting’ who’ll injure himself is virtually impossible; although on a group-level we do see some factors come back quite a bit:

• limited dorsiflexion
• reduced proprioception
• preseason deficiencies in postural control
• sports: basketball, volleyball, soccer on natural grass

Diagnosis

Before diagnosing an ankle injury as a sprain, you should exclude possible fractures with the Ottawa ankle rules.

This simple clinical algorithm can determine who needs an x-ray. If someone has a fracture, there’s a high probability that the patient will have a positive Ottawa test.

In cases where a haematoma is present, accompanied by pain on palpation around the distal fibula and/or a positive anterior drawer test, a rupture of the lateral ankle ligaments likely exists. To optimize the drawer test, you should wait 4 to 5 days post-injury.

Treatment

Simple rest, ice, compression, and elevation (RICE) — right?

There’s no evidence that RICE alone, or ice, or compression has any positive influence on pain, swelling, and function. Patients can use NSAID’s to mitigate pain although they may limit the natural healing process as inflammation is a necessary component. 

Immobilizing in a cast results in inferior outcomes compared to functional support and exercise strategies. If it’s applied for pain and swelling, it should be limited to 10 days.

Want to know a taping technique for ankle sprains? Watch the video below.

An inability to jump and land after 2 weeks after a first-time lateral ankle sprain is prognostic for chronic ankle instability so keep an eye out for these patients.

Exercise can reduce the prevalence of recurrent lateral ankle sprains as well as the prevalence of instability. Adding to this, exercise therapy is associated with a quicker time to recovery and enhanced outcomes. 

Unsurprisingly, therapies such as ultrasound, short-wave therapy, laser therapy, and electrotherapy have no value.

Chronic sprains

Chronic ankle sprains are a bit different. Watch this video if you want to learn more about them.

Reference

https://bjsm.bmj.com/content/bjsports/52/15/956.full.pdf