Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

TLDR

Ankle sprains are common, and ligament damage severity is best assessed by delayed physical examination, with sports participation increasing the risk of lateral sprains. This guideline updates evidence on the diagnosis, prevention, and treatment of ankle sprains, including the cost‑effectiveness of diagnostic procedures and therapeutic interventions. The guideline was revised by integrating recent research and evaluating diagnostic, therapeutic, and preventive strategies, as well as their cost‑effectiveness. The updated guideline recommends brief immobilization followed by tape or brace plus supervised exercise, cautions NSAID use due to potential healing suppression, reserves surgery for refractory cases, and endorses ankle braces for preventing recurrent sprains.

Abstract

This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.