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!
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Lamb SE, et al. "Mechanical supports for acute, severe ankle sprain" The Lancet, Volume 373, Issue 9663, Pages 575 - 581, 14 February 2009
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.
Cast for 4-7 days, then cam walker, gradually increasing ROM in the sagittal plane
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.