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The most common type of ankle sprain is an inversion injury. The ankle turns in. Inversion sprains are common complications that may occur after casual strolls, "trips", falls, and sports.
Most sprains are minor but the severe ones can result in ligament strain or rupture and cartilage injury to the bones within the ankle joint.
The most important risk factor for a new sprain is a previous sprain so comprehensive attention to a first sprain is critical.
A patient presenting with a sprain will have obvious swelling, discoloration, and point tenderness located in the anterolateral (front and slightly to the outside) ankle.
Physical examination may be difficult because of the pain a patient may be experiencing. X-rays should be obtained to exclude fracture. Also, any evidence of ankle instability should be a tip off that magnetic resonance imaging should be ordered to check for the integrity of ligaments. This last point cannot be overstressed enough since ligament tears, if not attended to quickly, can lead to chronic ankle instability.
For the acute injury, the age-old recommendation of RICE (rest, ice, compression and elevation) is still recommended. This should be followed until the initial swelling has subsided (generally 24-48 hours). Rest should be done with the leg elevated to reduce swelling. Compression can be achieved using an ace wrap or other ankle support. Ice should not be applied directly to the skin.
Analgesics such as acetaminophen can be used for pain. Non-steroidal anti-inflammatory drugs (NSAIDS) probably should be avoided since they can lead to less platelet adhesiveness, therefore causing more bleeding into the soft tissues.
Early mobilization is important.
Getting the patient active- ambulating- is important in preventing long-term disability.
When the ankle swelling and bruising has settled an active rehabilitation program should be started. A physical therapist can initiate specific treatments for pain relief and swelling such as ultrasound and advise the patient on proprioceptive (balance and proper sensation education) and muscle-strengthening exercises.
A patient may feel instability in the ankle. Strength and balance training will help this improve. Some people need additional mechanical support with orthotics (foot support) and ankle braces.
Athletes who have recurrent ankle sprains should be encouraged to do wobble board training intensively to prevent recurrence. Ankle taping prior to practice and matches or games is advised. There are several good athletic ankle supports available (eg., Swedo, Kalasi, Aircast, etc.)
Severe sprains are associated with ligament rupture, chip fractures, and cartilage injuries should have magnetic resonance imaging. Surgery may be necessary.
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