Diagnosis and treatment of ankle sprains - Tips from Other Journals

Date: Nov, 1990

Diagnostic and Treatment of Ankle Sprains Ankle sprain is the most common mustculoskeletal injury in athletes of all ages. Basketball players have the highest rate of ankle injuries, followed by the football players and croos country runners. Hergenroeder reviews the basic principles for the diagnosis and treatment of this common injury.

Eighty-five percent of ankle sprains are inversion injuries. The anterior and posterior talofibular ligaments and the calcaneofibular ligament are the structures most likely to be injured with inversion.

Eversion injuries are less common and are generally more serious. Deltoid ligament injury, fracture and disruption of the ankle mortise are more common with eversion injury.

Indications for referral of ankle injuries include the following: a structurally significant fracture> an obvious deformity> evidence of neurovascular compromise> a penetrating wound into the joint space> a sudden locking of the ankle> suspicion of a tendon rupture, and a syndesmotic injury. Radiographs of the ankle and foot are necessary in the evaluation of a complicated ankle injury.

The majority of inversion ankle sprains can be managed according to the "RICE" mnemonic (rest, ice, compression and elevation). Resting the ankle encourages healing. Walking and simple weight bearing are allowed, as long as the movement does not worsen the pain or swelling. If walking in a heel-toe gait causes pain, the use of crutches is necessary.

Ice applied to the ankle for up to 20 minutes at a time every two hours during the first two days after the injury reduces swelling and promotes healing. The ice should be placed in a plastic bag with a small amount of water to facilitate the bag conforming to the contour of the ankle.

Compression should be applied to the ankle to reduce joint space fluid and help stabilize the injury.

The ankle should be elevated as long as possible until swelling has stabilized. If the swelling decreases after the first several days, ankle stretching and strengthening exercises may be prescribed. Initiation of the RICE treatment within the first 36 hours has been associated with more rapid ankle rehabilitation. (American Journal of Diseases of Children, July 1990, vol. 144, p. 809.)

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