Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline
•Extrinsic risk factors(type of sport practiced) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS.
•When treating patients with an acute LAS, modifiable risk factors such as deficiencies in proprioception and ROM should be identified and if possible included in a prevention and/or rehabilitation programme to mitigate the risk for recurrent sprains.
•Extrinsic risk factors(type of sport practised) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS.
*Prognostic factors
Adequate attention should be directed towards the patient’s current level of pain, their workload and level of sports participation. These may all negatively influence recovery and increase the risk of future injury recurrence.
*Diagnostic
Regarding the clinical assessment of damage to the anterior talofibular ligament, the sensitivity (8️4%) and specificity (9️6%) of assessment using the anterior drawer are optimized if clinical assessment is delayed for between 4️ and 5️ days post injury. In case of a suspected fracture, the OAR should be applied.
*Treatment
•Rest Ice Compression Elevation (RICE)
There is no evidence that RICE alone, or cryotherapy, or compression therapy alone has any positive influence on pain, swelling or patient function.
•Non-steroidal anti-inflammatory drugs
NSAIDs may be used by patients who have incurred an acute LAS for the primary purpose of reducing pain and swelling. However, care should be taken in NSAID usage as it is associated with complications and may suppress or delay the natural healing process.
•Immobilization
Use of functional support and exercise therapy is preferred as it provides better outcomes compared with immobilization. If immobilization is applied to treat pain or oedema, it should be for a maximum of 10 days after which functional treatment should be commenced.
*Functional treatment
•Functional support
Use of functional support for 4–6 weeks is preferred over immobilization. The use of an ankle brace shows the greatest effects compared with other types of functional support.
•Exercise
Exercise therapy should be commenced after LAS to optimize recovery of joint functionality. Whether exercise therapy should be supervised or not remains unclear.
•Manual mobilisation
A combination with other treatment modalities, such as exercise therapy, enhances the efficacy of manual joint mobilization and is therefore advised.
•Surgical therapy
Despite good clinical outcomes of surgery after both chronic injuries and an acute complete lateral ligament rupture, functional treatment is still the preferred method as not all patients require surgical treatment.
•Other therapies
As no strong evidence exists on the effectiveness of these treatment modalities, they are not advised in the treatment of acute LAS.
*Prevention
•Functional support
Both tape and brace have a role in the prevention of recurrent LAS (limited evidence).
•Exercise therapy
It is advised to start exercise therapy, especially in athletes, as soon as possible after the initial sprain to prevent recurrent LAS. Exercise therapy should be included into regular training activities as much as possible as home-based exercise.
•Footwear
No recommendations can be made concerning shoe wear.
•Return to work
To speed up return to work, a brace and immediate functional treatment in combination with a return to work schedule are advised.
•Return to sports
Supervised exercises focusing on a variety of exercises such as proprioception, strength, coordination and function will lead to a faster return to sport.
