What is the best treatment for an ankle strain?

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New research concludes that immobilising an ankle is the most effective strategy for promoting a rapid recovery for acute ankle strain.

A recent study led by Professor Sara Lamb from the Warwick Clinical Trials Unit based at the University of Warwick has concluded that an aircast or below-knee cast can heed recovery following severe ankle sprain. This study challenges previous opinions, signifying that a short period of immobilisation can speed up a person’s recovery from an ankle sprain where symptoms are acute.

The results of the study were published in The Lancet on 13 February 2008. The study confirmed that attendances for acute ankle sprains account for between 3% and 5% of all UK accident and emergency attendances, which totals approximately 1 to 1½ million cases per year.

Ankle sprain injuries can range from a stretching of the ligament to a tear or rupture of the ligament complex. Symptoms can include swelling, inability to weight bear and significant pain and discomfort.

Previous research indicated that early management including applying ice, keeping the leg elevated and continued mobilisation of the joint was effective. Complete immobilisation was discouraged and therefore most UK accident and emergency departments use tubular compression bandages with advice to patients to exercise the limb.

The study involved the unit assessing the effectiveness of 3 different mechanical supports; the aircast brace, the bledso boot and a below-knee cast. These supports were considered an alternative to a double layer tubular compression bandage which is often used in treatment.

The trial assessed 584 patients with severe ankle sprain from 8 emergency departments across the UK. Patients had mechanical support within the first 3 days of attending hospital by a trained healthcare professional who provided advice on reducing swelling and pain. The functional outcome of these patients was measured over 9 months. The primary outcome assessed was the quality of ankle function after 3 months.

The research illustrated that patients who received the below-knee cast had a more rapid recovery than those given the tubular compression bandage.

Important clinical benefits were visible at 3 months in the quality of the ankle function as well as in the pain symptoms and activity. The patients who were given an aircast brace saw improvement in the quality of ankle function, however, there was little difference in the pain and symptoms they experienced. The bledso boot offered no advantage over the tubular compression bandage.

The differences between the treatments appear to be time sensitive as there is no significant difference between the tubular compression bandage with other treatments after 9 months.

It is therefore apparent from the studies that contrary to popular clinical opinion, immobilising an injury is the most effective strategy for promoting a rapid recovery.

This rapid recovery appears to be best achieved by the application of below-knee cast. The aircast brace was an alternative to the below-knee cast in terms of improving ankle function but the bledso boot tests were disappointing. The tubular compression bandage which is currently the most common treatment currently used was consistently the worst treatment.


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