Ankle Sprain

Immediate Therapy

The goal is to limit pain, limit swelling and maintain range of motion, then gradually introduce exercise.

PRICE

Protection, rest, ice, compression, and elevation (PRICE) is a common-sense approach for the first two to three days, although a formal study of its effectiveness is lacking.

• Protection is provided by applying an elastic bandage and, depending on the extent of injury, a splint, walking boot, or possibly a cast,

• Rest is achieved by limiting weight-bearing; if needed, patients use crutches until they are able to walk with a normal gait.

• Cryotherapy applied as ice or cold water immersion is recommended for 15 to 20 minutes every two to three hours while awake for the first 48 hours or until the swelling is improved, whichever comes first .

• Compression with an elastic bandage to provide support and minimize swelling should be applied early.

• The injured ankle should be kept elevated to further alleviate the swelling. Ideally, the ankle should be kept above the level of the heart, but this may be difficult to achieve.

ANALGESIA

• Paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs)

• No particular NSAID is superior

• Of the topical NSAIDs, gel formulations of diclofenac, ibuprofen, ketoprofen, and some diclofenac patches provided the best effect

PHYSIOTHERAPY

• Mainstay of treatment

• Range of motion exercises, including plantarflexion, dorsiflexion, and foot circles should be started early, once acute pain and swelling subside, to maintain range of motion

IMMOBILISATION AND BRACING

• Mild (grade I) and moderate (grade II) sprains don’t need a brace. Elastic wrap or compression sleeve is enough.

• Patients with moderate (grade II) lateral sprains may need sustained support following their injury.

• Three systematic reviews have reported that functional rehabilitation (ie, early activity and minimization of brace use) for lateral ankle sprains yields superior results for a number of clinically important outcomes compared with immobilization

REHAB

Functional rehabilitation is important in aiding the return to activity and preventing chronic instability and recurrent injury. This should be started in the first few days for grade I and II lateral ankle sprains and between days 7 and 14 for grade I and II isolated medial ankle sprains (depending on the degree of pain with weightbearing)