Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnosis and Treatment of Acute Ankle Sprain

족관절 급성 염좌의 진단과 치료

  • Byun, Chu-Hwan (Department of Orthopedic Surgery, Bucheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea) ;
  • Chung, Jin-Wha (Department of Orthopedic Surgery, Bucheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea)
  • 변주환 (가톨릭대학교 의과대학 부천성모병원 정형외과학교실) ;
  • 정진화 (가톨릭대학교 의과대학 부천성모병원 정형외과학교실)
  • Received : 2015.06.23
  • Accepted : 2015.07.24
  • Published : 2015.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Acute sprain of the ankle requires comprehensive history taking and physical examination in diagnosing the type of severity and deciding on the plan of treatment. Literature supports functional treatment as the treatment of choice for grade I and II injuries. During the acute phase, the goal of treatment focuses on controlling pain and swelling. PRICE (protection, rest, ice, compression, and elevation) is a well-established protocol at this phase. There is some evidence that application of ice and use of nonsteroidal anti-inflammatory drugs improves healing and speeds recovery. Then the functional treatment (motion restoration and strengthening exercises) is administered to progress the rehabilitation appropriately in order to facilitate healing and restore the mechanical strength and proprioception. Early mobilization has been shown to result in more rapid return to work and daily activities than immobilization. Grade III injuries still generate controversy in terms of the best management available, and more studies on early mobilization, cast immobilization, or surgery are needed. Even the Cochrane reviews published to date are not conclusive.

Keywords

References

  1. Denegar CR, Miller SJ 3rd. Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. J Athl Train. 2002;37:430-5.
  2. Kobayashi T, Gamada K. Lateral ankle sprain and chronic ankle instability: a critical review. Foot Ankle Spec. 2014;7:298-326. https://doi.org/10.1177/1938640014539813
  3. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008; 121:324-31. https://doi.org/10.1016/j.amjmed.2007.11.018
  4. O'donoghue DH. Treatment of ankle injuries. Northwest Med. 1958;57:1277-86.
  5. Balduini FC, Vegso JJ, Torg JS, Torg E. Management and rehabilitation of ligamentous injuries to the ankle. Sports Med. 1987;4:364-80. https://doi.org/10.2165/00007256-198704050-00004
  6. Dias LS. The lateral ankle sprain: an experimental study. J Trauma. 1979;19:266-9. https://doi.org/10.1097/00005373-197904000-00009
  7. Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot: systematic review. BMJ. 2003;326:417. https://doi.org/10.1136/bmj.326.7386.417
  8. Jackson DW, Ashley RL, Powell JW. Ankle sprains in young athletes. Relation of severity and disability. Clin Orthop Relat Res. 1974;(101):201-15.
  9. Griffith JF, Brockwell J. Diagnosis and imaging of ankle instability. Foot Ankle Clin. 2006;11:475-96. https://doi.org/10.1016/j.fcl.2006.07.001
  10. Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS. New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc. 2014;22:1701-7. https://doi.org/10.1007/s00167-013-2690-x
  11. Hua Y, Yang Y, Chen S, Cai Y. Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiol. 2012;53:1142-5. https://doi.org/10.1258/ar.2012.120171
  12. Kwon DG, Sung KH, Chung CY, Park MS, Kim TW, Lee SH, et al. Associations between MRI findings and symptoms in patients with chronic ankle sprain. J Foot Ankle Surg. 2014;53:411-4. https://doi.org/10.1053/j.jfas.2014.02.018
  13. Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull. 2011;97:105-35. https://doi.org/10.1093/bmb/ldq028
  14. Strauss JE, Forsberg JA, Lippert FG 3rd. Chronic lateral ankle instability and associated conditions: a rationale for treatment. Foot Ankle Int. 2007;28:1041-4. https://doi.org/10.3113/FAI.2007.1041
  15. Franson J, Baravarian B. Lateral ankle triad: the triple injury of ankle synovitis, lateral ankle instability, and peroneal tendon tear. Clin Podiatr Med Surg. 2011;28:105-15. https://doi.org/10.1016/j.cpm.2010.09.007
  16. Kaikkonen A, Kannus P, Jarvinen M. Surgery versus functional treatment in ankle ligament tears. A prospective study. Clin Orthop Relat Res. 1996;(326):194-202.
  17. Povacz P, Unger SF, Miller WK, Tockner R, Resch H. A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle. J Bone Joint Surg Am. 1998;80:345-51. https://doi.org/10.1302/0301-620X.80B2.8032
  18. Shrier I. Treatment of lateral collateral ligament sprains of the ankle: a critical appraisal of the literature. Clin J Sport Med. 1995;5:187-95. https://doi.org/10.1097/00042752-199507000-00009
  19. Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN. Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. J Bone Joint Surg Br. 2003;85:525-30. https://doi.org/10.1302/0301-620X.85B4.13928
  20. Pijnenburg AC, Van Dijk CN, Bossuyt PM, Marti RK. Treatment of ruptures of the lateral ankle ligaments: a meta-analysis. J Bone Joint Surg Am. 2000;82:761-73. https://doi.org/10.2106/00004623-200006000-00002
  21. Brooks SC, Potter BT, Rainey JB. Treatment for partial tears of the lateral ligament of the ankle: a prospective trial. Br Med J (Clin Res Ed). 1981;282:606-7. https://doi.org/10.1136/bmj.282.6264.606
  22. Clark BL, Derby AC, Power GR. Injuries of the lateral ligament of the ankle. Conservative vs. operative repair. Can J Surg. 1965;8:358-63.
  23. Gronmark T, Johnsen O, Kogstad O. Rupture of the lateral ligaments of the ankle: a controlled clinical trial. Injury. 1980;11:215-8. https://doi.org/10.1016/S0020-1383(80)80046-5
  24. Korkala O, Rusanen M, Jokipii P, Kytomaa J, Avikainen V. A prospective study of the treatment of severe tears of the lateral ligament of the ankle. Int Orthop. 1987;11:13-7. https://doi.org/10.1007/BF00266052
  25. Evans GA, Hardcastle P, Frenyo AD. Acute rupture of the lateral ligament of the ankle. To suture or not to suture? J Bone Joint Surg Br. 1984;66:209-12. https://doi.org/10.2106/00004623-198466020-00007
  26. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. 2007;(2):CD000380.
  27. Karlsson J, Sancone M. Management of acute ligament injuries of the ankle. Foot Ankle Clin. 2006;11:521-30. https://doi.org/10.1016/j.fcl.2006.07.008
  28. Snook GA, Chrisman OD, Wilson TC. Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am. 1985;67:1-7. https://doi.org/10.2106/00004623-198567010-00001
  29. Sommer HM, Arza D. Functional treatment of recent ruptures of the fibular ligament of the ankle. Int Orthop. 1989;13:157-60.
  30. Beynnon BD, Renström PA, Haugh L, Uh BS, Barker H. A prospective, randomized clinical investigation of the treatment of first-time ankle sprains. Am J Sports Med. 2006;34:1401-12. https://doi.org/10.1177/0363546506288676
  31. Kerkhoffs GM, Struijs PA, Marti RK, Blankevoort L, Assendelft WJ, van Dijk CN. Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review. Acta Orthop Scand. 2003;74:69-77. https://doi.org/10.1080/00016470310013699
  32. Weber JM, Maleski RM. Conservative treatment of acute lateral ankle sprains. Clin Podiatr Med Surg. 2002;19:309-18. https://doi.org/10.1016/S0891-8422(02)00003-4
  33. Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev. 2002;(3):CD002938.
  34. Bleakley CM, McDonough SM, MacAuley DC, Bjordal J. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med. 2006;40:700-5. https://doi.org/10.1136/bjsm.2006.025932
  35. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32:251-61. https://doi.org/10.1177/0363546503260757
  36. Thompson C, Kelsberg G, St Anna L, Poddar S. Clinical inquiries. Heat or ice for acute ankle sprain? J Fam Pract. 2003;52:642-3.
  37. Dalton JD Jr, Schweinle JE. Randomized controlled noninferiority trial to compare extended release acetaminophen and ibuprofen for the treatment of ankle sprains. Ann Emerg Med. 2006;48:615-23. https://doi.org/10.1016/j.annemergmed.2006.05.015
  38. Petrella R, Ekman EF, Schuller R, Fort JG. Efficacy of celecoxib, a COX-2-specific inhibitor, and naproxen in the management of acute ankle sprain: results of a double-blind, randomized controlled trial. Clin J Sport Med. 2004;14:225-31. https://doi.org/10.1097/00042752-200407000-00005
  39. Moran M. Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains. J Int Med Res. 1991;19:121-30. https://doi.org/10.1177/030006059101900205
  40. Kim KH, Ryu JH, Park MR, Kim YI, Min MK, Park YM, et al. Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial. BMJ Open. 2014;4:e004994. https://doi.org/10.1136/bmjopen-2014-004994
  41. van den Bekerom MP, van der Windt DA, Ter Riet G, van der Heijden GJ, Bouter LM. Therapeutic ultrasound for acute ankle sprains. Cochrane Database Syst Rev. 2011;(6):CD001250.