Lateral ankle sprains: a comprehensive review Part 2: treatment and rehabilitation with an emphasis on the athlete

Abstract

This is the second part of a two-part comprehensive review of lateral ankle sprains. In the first part of our review, we discussed the etiology, natural history, pathoanatomy, mechanism of injury, histopathogenesis of healing, and diagnostic approach to acute and chronic lateral ligamentous ankle injuries. Conservative intervention and treatment of grade I-III and chronic, recurrent sprains of the lateral ankle ligaments and appropriate rehabilitation guidelines are the topics of this article. We review the use and benefit of different modalities and external supports and outline our five-phase intervention program of rehabilitation based on the histopathogenesis of ligament healing. We discuss the expected timing of recovery of the acute injury as well as the management of chronic, recurrent ankle sprains. Treatment of acute ankle sprains depends on the severity of the injury. Conservative therapy has been found to be uniformly effective in treating grade I and II ankle sprains. Some controversy exists regarding the appropriate treatment of grade III injuries, particularly in high-level athletes. Our belief is that the majority of these patients may also be treated well with conservative management. Other options for the management of grade III sprains will be briefly discussed at the end of this article.

Short-Term Natural Recovery of Ankle Sprains Following Discharge From Emergency Departments

“…Active ROM and dorsiflexor torque were also lower on the injured side. In the laboratory, all measures were obtained dynamically at a fixed speed; therefore, if pain was a factor, then both joint excursion 27 and maximal muscle activation may have been reduced. 15 Indeed, both active and passive ROM were restricted compared to the uninjured side, and the extent of the asymmetry was associated with total ankle function.…”

Deficits in Detection of Inversion and Eversion Movements Among Subjects With Recurrent Ankle Sprains

“…An ankle inversion sprain was defined as an inversion injury that resulted in swelling, pain over the lateral ligaments, and abnormal gait. 18,26 Subjects with a recent sprain (within 3 weeks of testing) were excluded to avoid the possibility of any associated pain and swelling that might affect the results. Subjects were also excluded from either group if they had a neurological deficit, such as vestibular or balance disorders, or had sustained any injury to the leg that might impair proprioceptive acuity, such as previous surgery or fracture.…”

An Obturator Reduces Time for Volumetric Measurements of the Foot and Ankle

“…Swelling in the lower limb can follow immobilization, 1 surgery, 6,11,17 or trauma such as an ankle sprain. 14,16,21 Assessment and reduction of swelling should be pursued vigorously, especially after trauma, 19 because fibrinous exudation and swelling of capillary endothelial cells can result in scar tissue formation that impedes rehabilitation. 18 Different methods are used to measure volume of the foot and ankle, such as the figure-of-eight method with a tape, 12 and water displacement volumetry.…”