Am Fam Physician. 2012;85(12):1170-1176
Patient information: See related handout on how to care for an ankle sprain, written by the author of this article.
Author disclosure: No relevant financial affiliations to disclose.
Ankle sprains are a common problem seen by primary care physicians, especially among teenagers and young adults. Most ankle sprains are inversion injuries to the lateral ankle ligaments, although high sprains representing damage to the tibiofibular syndesmosis are becoming increasingly recognized. Physicians should apply the Ottawa ankle rules to determine whether radiography is needed. According to the Ottawa criteria, radiography is indicated if there is pain in the malleolar or midfoot zone, and either bone tenderness over an area of potential fracture (i.e., lateral malleolus, medial malleolus, base of fifth metatarsal, or navicular bone) or an inability to bear weight for four steps immediately after the injury and in the emergency department or physician's office. Patients with ankle sprain should use cryotherapy for the first three to seven days to reduce pain and improve recovery time. Patients should wear a lace-up ankle support or an air stirrup brace combined with an elastic compression wrap to reduce swelling and pain, speed recovery, and protect the injured ligaments as they become more mobile. Early mobilization speeds healing and reduces pain more effectively than prolonged rest. Pain control options for patients with ankle sprain include nonsteroidal anti-inflammatory drugs, acetaminophen, and mild opioids. Because a previous ankle sprain is the greatest risk factor for an acute ankle sprain, recovering patients should be counseled on prevention strategies. Ankle braces and supports, ankle taping, a focused neuromuscular training program, and regular sport-specific warm-up exercises can protect against ankle injuries, and should be considered for patients returning to sports or other high-risk activities.
Acute ankle sprain is one of the most common reasons for primary care office and emergency department visits in the United States, with an overall incidence of 2.15 per 1,000 person-years. 1 Teenagers and young adults have the highest rates of ankle sprain, with a peak incidence of 7.2 per 1,000 person-years for those 15 to 19 years of age. 1 Nearly one-half of all ankle sprains occur during athletic activity, with basketball being the most commonly involved sport. 2 The greatest risk factor for ankle sprain is a previous ankle sprain, which underscores the importance of proper treatment and effective prevention strategies.
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| The Ottawa ankle rules should be used to rule out fractures and prevent unnecessary radiography in patients with suspected ankle sprain. | A | 6 , 7 |
| Cryotherapy should be applied for the first three to seven days to reduce pain and improve recovery time in patients with ankle sprain. | B | 11 – 13 |
| An air stirrup brace combined with an elastic compression wrap, or a lace-up support alone, reduces pain and recovery time after an ankle sprain and allows early mobilization. | B | 15 – 17 |
| Early mobilization and focused range-of-motion exercises reduce pain and recovery time after an ankle sprain, and are preferred to prolonged rest. | B | 18 , 19 |
| Patients at risk of reinjury after an ankle sprain should participate in a neuromuscular training program. | B | 35 , 36 |
| Air stirrup braces, lace-up supports, and athletic taping can reduce the risk of ankle sprains during sports. | B | 39 , 40 |