Did you know that two of the most common ankle injuries, specifically for sports, include ankle sprains and ankle fractures? Ankle sprains occur in 600-700 per 100,000 persons, and ankle fractures happen in 107-187 per 100,000 persons per year. After a sprain, persistent symptoms may linger for up to 30% of individuals, and a history of an ankle sprain remains a predisposing factor for recurrent future ankle sprains. Similarly, after an ankle fracture, symptoms may limit lower limb activities and persist long term.
This study aimed to identify the current treatments for ankle sprains and ankle fractures using the most recent systematic reviews and randomized controlled trials.
Treating Ankle Sprains:
Ankle sprains are usually managed conservatively; the acute phase involves symptom management followed by a period of rehabilitation. Current evidence supports the use of non-steroidal anti-inflammatory drugs (NSAIDs) and functional support during the immobilization or acute stage of an ankle sprain. When compared with a placebo, the participants who used NSAIDs during the first two weeks following the sprain reported a significant improvement in function in the long term. Functional support implies the use of braces, elastic bandage, tape, semi-rigid support, and lace-up ankle support over the injured ankle. Studies have found all supports equally effective in decreasing pain, swelling, preventing recurrent sprains, and providing support for ankle instability. When compared to adults who didn’t use functional support, the group of adults who used this form of support demonstrated greater range of motion (ROM), less persistent swelling, and reported a higher percentage of return to sports or work-related activities. Additionally, performing balance and ankle strengthening exercises during and after the subacute phase is beneficial for those with chronic ankle instability and those predisposed to recurrent ankle sprains.
According to the review, electro-physical agents (Ex: TENS Unit) were not recommended during the acute stage of an ankle sprain. There is weak evidence for the use of manual therapy for positive short-term or acute effect and this could be partially attributed to small randomized controlled trials and cross-over studies. Nonetheless, in one study, manual therapy has shown to increase ankle function up to one month following the treatment. In addition, current evidence proves that Mulligan’s mobilization with movement technique (anterior to posterior glide of the talus) during the subacute phase, is effective in increasing dorsiflexion range for participants with Grade 2 ankle sprains.
Treating Ankle Fractures:
As opposed to ankle sprains, ankle fractures usually involve surgical or a conservative fracture reduction and are followed by immobilization and rehabilitation. Usually, rehabilitation for ankle fractures is followed after the period of immobilization. This study suggests that early rehabilitation including weight-bearing exercises with an orthosis or brace during the immobilization phase may be beneficial for people after surgical fixation. In one randomized controlled trial, using an orthosis with ankle exercises led to better outcomes in function and ankle range of motion when compared to the group that only received cast immobilization. However, it is important to note that the use of a brace or orthosis to allow for exercise during the immobilization period of a fracture may also lead to a higher rate of adverse effects. Caution must be taken as early mobility during the acute stage may only be tolerable for some individuals. Current evidence on treatments for ankle fracture suggests the use of manual therapy, a gradual increase in activities, and a structured exercise program to enhance outcomes for individuals following immobilization.
Summary
Evidence-based treatment of acute ankle sprains should include functional support and NSAIDs during the acute phase after the injury. Manual therapy may also provide additional benefits during the subacute phase. Additionally, performing ankle strengthening and stabilization exercises have been shown to reduce recurrent sprains and chronic ankle instability. After an ankle fracture, current evidence supports early weight-bearing during the immobilization period for patients who are able to do so safely. After the immobilization period, treatment should be structured with a comprehensive and progressive exercise program.
The physical therapists at Physical Therapy First are trained and equipped to provide you with this specific care while meeting your individual needs. Questions? Feel free to contact any of our skilled therapists by phone or by appointment.
References:
Lin CW, Hiller CE, de Bie RA. Evidence-based treatment for ankle injuries: a clinical perspective. J Man Manip Ther. 2010;18(1):22-28. doi:10.1179/106698110X12595770849524