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Jonathan Cluett, M.D.

Immobilization of Ankle Sprains

By October 1, 2009

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Ankle sprains are a common condition that is found among elite athletes and couch potatoes, and everyone in between. The best treatment of an ankle sprain can be controversial, and a recent report in the journal The Lancet has further complicated the understanding of ankle sprain treatment.


The study found that immobilization was helpful in patients who had sprained their ankle. Patients in the study who were immobilized initially had a faster recovery with better ankle function within 3 months from the time of injury. The study found no difference in function between patients immobilized, and those treated without immobilization, after 9 months.

So why not cast all ankle sprains? It is my belief, that immobilization tends to lead to scar tissue formation, and an increased likelihood of recurrent (repeat) ankle sprians. If the healing ligament is subjected to normal forces and motions, the hope is that the ligament will heal in a more normal manner. Immobilization may lead to scarring of the ligament, and potential for long-term problems--the study did not investigate this theory.

What do you think? Should an ankle sprain be immobilized? Feel free to comment below!


Image © www.istockphoto.com

Lamb SE, et al. "Mechanical supports for acute, severe ankle sprain" The Lancet, Volume 373, Issue 9663, Pages 575 - 581, 14 February 2009

Comments
April 29, 2009 at 2:48 pm
(1) Matt says:

I would recommend immobilizing in a high quality removable boot cast like VACOcast, http://www.vacocast.com, NOT a less stable cheap camwalker, and letting the patient perform physical therapy every day to avoid ligament scarring.

October 6, 2009 at 3:13 pm
(2) Jim D says:

Cast for 4-7 days, then cam walker, gradually increasing ROM in the sagittal plane

March 23, 2010 at 12:06 am
(3) Greg Williams says:

I did the RICE thing and the swelling still hasn’t gone down. The compression bandage didn’t offer much support so I bought an inflatable walker boot from a local med supply store (pricey!) and it made made a world of difference. There is less pain since the joint is immobilized.

June 2, 2012 at 11:52 pm
(4) torn ligament behind knee says:

Amazing things here. I am very satisfied to peer your article. Thanks so much and I’m having a look forward to contact you. Will you kindly drop me a e-mail?

October 8, 2013 at 4:53 pm
(5) B says:

I have always been a bit of a daredevil. So, I’ve got a lot of experience with injuries and the ways a doctor treats them. I can’t see the benefit of a hard cast for sprains. It seems like the soft tissue would get very tight in there with no way to stretch. I had the simplest scaphoid break in the world one year. The bone mended perfectly in 7 weeks. It took a year of gradually increasing weightlifting, careful massage and stretching to pop out all the soft tissue kinks. The aircast stirrup is a joke unless you are just holding things still until the swelling goes down. The inflatable aircast boot is great for holding a heelbone in place, but the pressure reacts unpredictably with the body’s own pressure and it gets too tight if left pumped while elevated. My most recent sprain was treated with a slightly higher tech vacocast, which uses a beanbag system to conform with a hardening supportiveness which is very similar to a hard cast, but has a bit of flex and is removable for showering and sleeping. It also has a custom angle setting if your ankle doesn’t feel good exactly at 90 degrees. Aircast and vacocast each have pros and cons. If you are a “Jackass” type and constantly getting little tweaks and small fractures, I’d just go ahead and buy both.

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