TREATMENT

ANKLE SPRAIN
Functional rehabilitation is our frst-line treatment for a patient ith a simple an!le
sprain" Treatment mo#alities such as lon$-term immobili%ation an# sur$ical
mana$ement ha&e resulte# in sloer return to acti&it'( hi$her cost( an# more
complications ithout better e)ecti&eness" *ur initial mana$ement inclu#es RI+E
,Rest( Ice( +ompression( an# Ele&ation- an# anti in.ammatories for pain control/ use
of crutches for $ra#e 0 an# 1 in2uries is #iscoura$e#" A short perio# of
immobili%ation an# protecti&e bracin$ is implemente# ne3t" Then earl'( acti&e ran$e
of motion/ propriocepti&e trainin$/ peroneal stren$thenin$/ an# sport-specifc
e3ercises are starte#" The athlete ma' return to sports acti&it' after the pain has
resol&e# an# an!le stren$th is e4ual to that of the opposite si#e"
At 5u!e 6ni&ersit' Me#ical +enter( the ma2orit' of $ra#e 0 sprains are #ia$nose#
an# mana$e# b' trainers/ referrals to orthope#ists for these in2uries are rare" Return
to acti&it' usuall' occurs after 7 to 8 #a's for $ra#e 0 sprains an# after 0 to 7
ee!s for $ra#e 1 sprains/ it ta!es lon$er for $ra#e 7 sprains( an# an!le protection
ma' be re4uire# for up to 9 months" Referral to an orthope#ic sur$eon is in#icate#
in the acute phase for in2uries ith se&ere la3it'( fracture# bone( or me#ial
ecch'mosis" In 0:; to 1:; of athletes( initial treatment is unsuccessful an#
orthope#ic referral shoul# be consi#ere#" Sur$ical proce#ures for chronic
instabilit'( such as the <rostrom-=oul# repair( ha&e ha# e3cellent results"
S>N5ESM*TI+ IN?6RIES
S'n#esmotic in2uries ma' be #i&i#e# into 7 t'pes" T'pe 0 in2uries in&ol&e
si$ns of s'n#esmotic sprain ith normal 3-ra' fn#in$s" The' ma' be
mana$e# ith functional rehabilitation similar to the protocol use# for simple
sprains" A t'pe 1 in2ur' is #emonstrate# b' a tibiofbular clear space $reater
than 9 mm measure# 0 mm abo&e the 2oint seen in a stress 3-ra' &ie"
Treatment consists of non@ei$ht bearin$ in a short le$ cast for A ee!s
folloe# b' ei$ht bearin$ in an immobili%ation boot for A more ee!s"
5ia$nosis of a t'pe 7 in2ur' is ma#e b' fran! #iastasis on the nonstress
ra#io$raphs/ imme#iate referral to an orthope#ic sur$eon for sur$ical
stabili%ation is re4uire#" Return to pla' for t'pe 0 an# 1 in2uries a&era$es B
to 01 ee!sCtice as lon$ as ith a se&ere lateral an!le sprain"
Reference
Saluta( ?onathan" Mana$in$ foot an# an!le in2uries in athletes" ?ournal *f
Musculos!eletal Me#" September 1:0: