Roughly 85% of all acute ankle injuries are sprains,1 of which about 85% are uncomplicated, involving the lateral ligaments only.2 The anterior talofibular ligament is the most susceptible to injury followed by the calcaneofibular ligament. A grading system based on the level of injury to 1 or more ligaments is often used to describe lateral ankle sprains. The anterior drawer and talar tilt tests, which determine clinical instability, are also emphasized in the evaluation of ankle sprains. However, neither the grade of the injury nor the results of instability tests influence the treatment program.3
Studies have shown that the occurrence and persistence of soft tissue swelling and the associated loss of pain-free range of motion and strength in sprained ankles delay the patient's return to full activities more than any other factor.3 Thus, the prevention or elimination of soft tissue swelling is paramount in the management of lateral ankle sprains.
Evidence also shows that recurrence of lateral ankle sprains is high when the patient does not do the following:
•Regain full pain-free range of motion.
•Regain normal strength.
•Use an ankle brace specifically designed to prevent recurrence.3-5
Patients with uncomplicated lateral ankle sprains can be expected to respond well to a comprehensive program designed to prevent or eliminate soft tissue swelling and regain full pain-free range of motion and normal strength of the muscles that stabilize the ankle.6,7
In this second article of our 2-part series, we provide a 6-step comprehensive treatment program for uncomplicated lateral ankle sprains. In part 1, Office Evaluation and Management (CONSULTANT, June 2009), we reviewed the 8 less common injuries—5 fractures and 3 significant soft tissue injuries—that must be considered when evaluating acute ankle injuries. We also included a step-by-step guide for how best to evaluate the patient with an acute ankle injury.