How are ankle sprains treated?

Ankle sprains can be treated non-operatively or operatively. The treatment goal is to stabilize the ankle, prevent any further abnormal motion, and rehabilitate the ankle to full strength. The treatment plan is determined by the severity of the injury. Patients with an ankle fracture will often require surgery from an orthopedic surgeon.

Non-Operative Treatment

Most ankle sprains require Rest, Ice, Compression and Elevation (RICE), followed by rehabilitation and muscle strengthening. When the ankle sprain is managed immediately with RICE, symptoms may be minimized despite the severity of injury.

Painful activities that may extend the injury or prevent full recovery should be avoided. When walking, a support or brace will help prevent re-injury. Ligaments heal best with minimal stress, so limited walking while protected by a brace or cast is recommended. Crutches are prescribed in most cases, but are not necessary in the recovery if the patient has a mild sprain that is immediately supported by a brace.

Ice is applied to reduce the amount of swelling and relieve the pain. Crushed ice placed in a waterproof plastic bag with a small amount of water is recommended immediately after injury. Crushed ice is preferred, as it easily conforms to the shape of the ankle and provides cold within the joint where the ligaments are located. The ice bag can be secured in place with an elastic bandage or plastic wrap. The skin should be monitored for frostbite. Ice should be applied for 20 minutes every 4 hours until the swelling stabilizes. A satisfactory alternative to crushed ice is a bag of frozen corn or peas wrapped around the injured ankle with plastic wrap. Heat is not recommended as it may increase the amount of swelling. Other alternatives to crushed ice are "instant ice" and frozen gel, but both of these options are not as effective as crushed ice.

Wrapping the ankle with an elastic wrap from the toes to above the ankle will give mild support. Most physicians prescribe an elastic bandage or brace that will compress and support the ankle. The additional pressure of the wrap further minimizes swelling. Taping of the ankle for less severe sprains will provide support and a level of confidence to the injured person as ankle movements are regained. Padding, such as six to eight layers of four inch square cotton pads or disposable diapers, should be firmly placed under the elastic wrap, as ankle sprains usually occur in areas where the wrap alone would be ineffective.

The sprained ankle should be elevated above the waist to relieve discomfort and prevent additional swelling. The ankle should be propped up on pillows, especially at night.

Another important element of the non-operative treatment program is Protection. This changes the RICE formula to PRICE. Protection takes the form of casting or using a walking boot for the more severe unstable ankle sprain. A stirrup type brace (such as the Aircast Air Stirrup brace) is quite effective for protecting the majority of ankle sprains. Overall, the key to a successful treatment plan is early weightbearing, supported by a brace, and rehabilitation. In severe cases, a walking boot is prescribed for a few weeks and the patient is instructed to put weight on the ankle.

In addition to rest, the physician may recommend a non-steroidal anti-inflammatory agent such as ibuprofen to help decrease the pain and reduce inflammation within the injured ankle. Individuals with a history of drug sensitivity, known kidney or liver problems, or a bleeding disorder, should not use these medications. People with a history of stomach irritation or ulcers should not take anti-inflammatory medication without physician advice or supervision.

Operative Treatment

Potentially unstable Grade III sprains should be evaluated by an orthopedic surgeon within a few days of the injury. Surgery for a sprained ankle is rarely necessary, although some very severe sprains and some ankle fractures will require an operation. Most patients recover satisfactorily by following a non-operative treatment plan prescribed by their physicians.

In the case of a very severe ankle sprain which requires surgery:

  • The incision is made directly over the area of the torn ligaments.
  • The torn ends of the ligaments are identified and the joint is inspected for any debris.
  • The ligaments are repaired with sutures or reattached to the bone with suture anchors prior to closing the skin.
  • After the skin is closed, a protective splint is applied.

Post-operative immobilization is required for three to six weeks before rehabilitation begins.

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