Treatment Options for Ankle Sprains

Treatment plans for the sprained ankle are doctor and patient dependant. The spectrum ranges from immobilization with cast or splint to surgical repair of the damaged ligaments. Studies have shown 75 to 100 percent good to excellent outcomes with both non-surgical and surgical treatment plans [13]. Surgical treatment of acute ankle sprains is normally reserved for those sprains that also involve a fracture or in cases of competitive athletes. By following proper treatment, most ankle sprains heal within two to six weeks, but may take longer depending on injury severity and patient compliance.

RICE Therapy: No, Uncle Ben’s will not relieve your ankle pain. RICE is an acronym for rest, ice, compression and elevation—the initial steps in treating most traumatic injuries. Swelling is the body’s way of forcing you to rest and avoid further injury. This may require the use of crutches or a walker to assist during ambulation. Gradual increases in activity level should be directed by your physician to reduce the risk of re-injury and setbacks. Unfortunately, the edema (swelling) that forces you to rest can also cause pain due to stretching of nerves and irritation of surrounding muscles and tendons. Applying ice in 15 to 20 minute intervals several times a day to the injured ankle is a good way to reduce swelling and control pain. A bag of frozen vegetables does a fantastic job of conforming to the joint. Application of ice to skin for longer than 20 minutes at a time can result in injury, so caution is advised. Compression therapy, consisting of elastic wraps, air casts, splints or soft casts, assists in the reduction of edema and protects the ankle from movement that may result in re-injury. Elevating the injured part is important to avoid increased edema in the ankle due to pooling of blood as a result of gravity. Keeping the ankle elevated on 2-3 pillows, ideally above heart level, will decrease swelling and pain of your injury.

Anti-Inflammatory Medication: The use of non-steroidal anti-inflammatory drugs (NSAIDs) in over-the-counter or prescription strengths can provide pain relief and reduce swelling around the ankle. These medications may not be appropriate for all patients—a thorough history should be performed by your foot and ankle specialist to ensure the safe use of these medications.

Ankle Support: Patients will likely require a form of ankle brace to provide support and stabilization to prevent abnormal motions responsible for injury. Bracing may include air splints, lace-up ankle braces, elastic wraps, taping or removable cast boots.

Crutches: Although less severe injuries may permit a patient to walk unassisted, it is not recommended practice. Because ankle injuries are such insidious creatures, it is ‘best to rest’ the ankle as much as possible within the first days following the injury. Depending on your physical conditioning, other modalities may be considered (i.e., wheelchair or walker).

Physical Therapy: Mobilization of the ankle should be performed as soon as tolerated to avoid long-term stiffness and swelling of the joint [13-15]. A physical therapy program consisting of range of motion exercises, stretching, and muscle strengthening can be implemented for this purpose.

Another component of this rehabilitation process includes retraining the ankle joint to protect against abnormal movements. Proprioception is the body’s ability to sense movement and position of body parts. Nerve endings in the ankle joint and the muscles that surround the joint may be injured during an ankle sprain. Retraining these nerve endings facilitates the return to normal activity and the body’s ability to protect itself against abnormal motion. This is accomplished by using physical therapy devices such as a wobble board to retrain the ankle for uneven surfaces.

Shoegear: Shoes worn after ankle injury should have greater support around the heel and may extend above the ankle joint to provide additional stability. Trained personnel at your local athletic store can direct you to the shoes that would best support your vulnerable ankle.