What is the role of casts and splints in the acute treatment of ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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However, results from the Collaborative Ankle Support Trial (CAST) indicated that there are benefits to the use of a below-knee cast for 10 days. CAST was a randomized, controlled trial designed to estimate the clinical effectiveness and cost-effectiveness of 3 methods of ankle support compared with double-layer, tubular compression bandage. The below-knee cast and the Aircast brace (applied 2-3 days after injury, to allow time for swelling to resolve) offered cost-effective alternatives to tubular bandages for acute, severe ankle sprains, with the below-knee cast having the advantage in terms of overall recovery at 3 months. Because no differences in long-term outcome were noted, the investigators suggested that practitioners should consider likely compliance and acceptability to patients when choosing a brace. [51]

Occasionally, the use of posterior splinting and crutches with non–weight-bearing ambulation is helpful for more severe ankle sprains (ie, when foot motion and weight bearing are extremely painful). Usually, the use of a posterior splint is limited to a few days, and weight bearing as tolerated is encouraged.

In general, ankle splints are applied to minimize movement and provide support and comfort by stabilizing an injury at that joint. Splints are primarily used to stabilize injuries to bones until the patient can be evaluated by a consultant, such as an orthopedic surgeon. Splints are also used to achieve immobilization for primary healing or in the presurgical period. All patients with injuries that are splinted should be referred for evaluation by a consultant in a timely fashion (usually within 2-3 d).

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