Guideline sources The following summarized guidelines for the evaluation and management of ankle sprain are prepared by our editorial team based on guidelines from the Dutch Orthopaedic Society (DOS 2018). 1 2 2 2 2 Definition An ankle sprain is an injury to the lateral ligament complex of the ankle joint. 2 Epidemiology A traumatic inversion and adduction of the plantar flexed foot is the most common cause of an ankle sprain. Risk factors include a previous ankle sprain, a history of ligament hyperlaxity syndrome, and anatomical misalignments (crus varum and pes cavo-varus). 2 Disease course The inversion and supination of plantar flexed foot result in an ankle sprain, which causes clinical manifestations of pain, intermittent swelling localized to the lateral side of the affected ankle, mechanical instability, and stiffness. Persistent or recurrent instability can lead to degenerative changes in the cartilage. 2 Prognosis and risk of recurrence https://web.pathway.md/diseases/recwviXlMJ8BdmmWG 1/3 6/23/23, 2:36 AM Ankle sprain Pathway An ankle sprain is not associated with an increase in mortality. 2 Calculator Ottawa ankle rule Guidelines 1. Diagnostic investigations Clinical evaluation: identify modifiable risk factors such as deficiencies in proprioception and ROM when treating patients with an acute lateral ankle sprain. B Show 2 more 2. Medical management Nonsteroidal anti-inflammatory drugs: consider administering NSAIDs to reduce pain and swelling in patients with an acute lateral ankle sprain, balancing these benefits with the risks of drug-induced adverse events and possible delayed tissue healing. C 3. Nonpharmacologic interventions Rest, ice, compression and elevation: avoid using only rest, ice, compression, and elevation (RICE) in the management of ankle sprains, as there is no evidence that this combination of interventions alone has a positive influence on pain, swelling or patient function. D Functional support: advise exercise therapy with functional support, rather than joint immobilization, as this has been associated better outcomes compared with immobilization. Maintain immobilization for a maximum of 10 days, if used to treat pain or edema, after which functional treatment should be initiated. B Special shoe wear: insufficient evidence to make a conclusive recommendation regarding special shoe wear for the management of ankle sprains. I Exercise therapy: Advise exercise therapy in patients with lateral ankle sprains, in order to optimise recovery of joint functionality. A Insufficient evidence to recommend whether exercise therapy should be supervised or not. I 4. Surgical interventions https://web.pathway.md/diseases/recwviXlMJ8BdmmWG 2/3 6/23/23, 2:36 AM Ankle sprain Pathway Ligament repair: Implement nonoperative treatment as first-line therapy in most patients with ankle sprains, as not all patients require surgical treatment. A Avoid operative treatment in acute ankle sprains, as there is no strong evidence to support their effectiveness in this setting. D 5. Preventative measures Rehabilitation programs: refer patients with an acute lateral ankle sprain in whom deficiencies in propriorception and ROM have been identified to a prevention and/or rehabilitation programme to mitigate the risk for recurrent sprains. B Taping and bracing: consider both tape and brace for the prevention of recurrent lateral ankle sprains, despite a limited understanding of the mechanisms that leads to their beneficial effects. B References 1. Vuurberg G, Hoorntje A, Wink LM et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52 15 956. Open 2. Peter Aa Struijs, Gino Mmj Kerkhoffs. Ankle sprain. 2010 May 13;2010 1115.2010 May 13;2010 1115. Open 3. Martin RL, Davenport TE, Paulseth S et al. Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther. 2013 Sep;43 9 A1 40. Open https://web.pathway.md/diseases/recwviXlMJ8BdmmWG 3/3