UMEM Educational Pearls

Title: Ankle Sprains

Keywords: Ankle Sprain, Treatment (PubMed Search)

Posted: 2/14/2009 by Michael Bond, MD (Updated: 4/26/2024)
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Ankle sprains are typically treated with a short period of immbolization and then functional exercises are prescribed to rehabilitate the ankle. A study published in the Lancet this week might just change that. Lamb et al looked at 584 people with severe ankle sprains (unable to weight bear 3 days out from injury) that were randomized to be treated with a 10 day below knee cast, Aircast, Bledshoe Shoe or Tubular Compression dressing (similar to Ace Wrap). Those that were treated with the Cast and Aircast had quicker return to function and less disability at 3 months. There was no increased risk of DVTs in the cast group.

A commentary in the same issue points out that severe ankle sprains are associated with:

lower levels of physical activity levels
recurrent ankle sprains are often reported for months and years after initial injury.
About 30% of patients with an initial ankle sprain develop chronic ankle instability, or repetitive giving way of the ankle during functional activities.
There is also emergent evidence to link severe and repetitive ankle sprains to increased risk of ankle osteoarthritis.

Based on this article I think it is prudent to treat all patients with severe Ankle Sprains with a prolonged period of forced immobilzation (Posterior Splint, Short Leg Cast or Aircast). I would also recommend the Aircast be used to prevent recurrent sprains especially if the patient is involved in sports that require jumping (Basketball, Volleyball) where the risk of reinjury is higher.

References

Mechanical supports for acute, severe ankle sprain:a pragmatic, multicentre, randomised controlled trial
S E Lamb, J L Marsh, J L Hutton, R Nakash, M W Cooke, on behalf of The Collaborative Ankle Support Trial (CAST Group)*. Lancet 2009; 373: 575–81

Immobilisation for acute severe ankle sprain [Commentary] Hertel J. Lancet 2009; 373: 524-526