Acute ankle sprain: an update

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Am Fam Physician. 2006 Nov 15;74(10):1714-20.

Acute ankle sprain: an update.

Ivins D.

Department of Family Medicine, University of Oklahoma College of

Medicine-Tulsa, Tulsa, Oklahoma 74102, USA.

Acute ankle injury, a common musculoskeletal injury, can cause ankle

sprains. Some evidence suggests that previous injuries or limited

joint flexibility may contribute to ankle sprains. The initial

assessment of an acute ankle injury should include questions about

the timing and mechanism of the injury. The Ottawa Ankle and Foot

Rules provide clinical guidelines for excluding a fracture in adults

and children and determining if radiography is indicated at the time

of injury. Reexamination three to five days after injury, when pain

and swelling have improved, may help with the diagnosis. Therapy for

ankle sprains focuses on controlling pain and swelling. PRICE

(Protection, Rest, Ice, Compression, and Elevation) is a well-

established protocol for the treatment of ankle injury. There is

some evidence that applying ice and using nonsteroidal

antiinflammatory drugs improves healing and speeds recovery.

Functional rehabilitation (e.g., motion restoration and

strengthening exercises) is preferred over immobilization.

Superiority of surgical repair versus functional rehabilitation for

severe lateral ligament rupture is controversial. Treatment using

semirigid supports is superior to using elastic bandages. Support

devices provide some protection against future ankle sprains,

particularly in persons with a history of recurrent sprains. Ankle

disk or proprioceptive neuromuscular facilitation exercise regimens

also may be helpful, although the literature supporting this is

limited.