What is included in the conservative treatment of ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Rest, ice, compression, and elevation (ie, RICE) are the mainstays of acute treatment; more comprehensively, the combination of protection, relative rest, ice, compression, elevation, and support (PRICES) is used. [1]

Protective devices include air splints or plastic and Velcro braces. Most sprains can be treated without casting. Depending on the severity of the sprain, protective devices are used for 4-21 days. Criteria for discontinuing use of a device include minimal swelling and pain at the site of injury. The ROM should be smooth, particularly with dorsiflexion and plantar flexion.

Relative rest is advocated, because it promotes tissue healing. Advise the patient to avoid activities that cause increased pain or swelling. Advocate early, pain-free movements during this time. Encourage patients to take their ankle out of their brace and move it through a pain-free ROM. Aggressive pain-free ROM is recommended. Having patients spell the letters of the alphabet with their foot and ankle several times per day is one simple activity to recommend even in an acute care setting.

Use ice to control swelling, pain, and muscle spasm. As a rule, do not apply ice or cold packs directly to the skin; wrap the pack in a towel before use. Recommend that the patient apply ice for 15-20 minutes, 3 times daily. Contrast baths can be used 24-48 hours after injury.

Recommend the use of compression with an ACE wrap, an elastic ankle sleeve, or a lace-up ankle support. Advise the patient that further support of the ankle can be facilitated by wearing high-top, lace-up shoes. This can help to minimize edema. [3]

Encourage elevation of the injured ankle to facilitate the reduction of swelling. Advise the patient to keep the ankle above the level of the heart.

Support can include taping or the use of lace-up ankle supports with combination hook-eye (ie, Velcro) straps. [3]


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