What are the treatment options for chronic recurrent ankle sprains?

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

For recurrent lateral ankle sprains, treatment should begin with a trial of conservative therapy for approximately 2-3 months. The treatment goals include the patient regaining full strength in the affected ankle, being provided protective support as needed, and returning to activity participation. These goals are accomplished through ROM and strength exercises, sports-specific functional progression, protective support as needed, and weight-bearing, multidirectional balance exercises. [74]

Other therapeutic strategies include the use of lateral heel wedges, peroneal muscle strengthening, proprioceptive/coordination exercise, taping, and ankle-foot orthoses with ankle and subtalar support. [75] However, these options are seldom accepted on a long-term basis (especially in athletes), and surgical stabilization is, in many cases, the treatment of choice.

For recurrent sprains that involve the medial ligaments, slight modifications to the conservative treatment of lateral sprains are used. These include ankle stirrup bracing, casting, and orthoses (in addition to physical therapy). Once again, if these measures are unsuccessful, surgical intervention is necessary.

In syndesmotic injuries, when a diastasis has been present for longer than 3 months, significant arthritic changes have probably begun. Diastasis refers to any loosening in the attachment of the fibula to the tibia at the inferior tibiofibular joint. In most cases, arthroscopic evaluation of the ankle joint is helpful in determining the best course of management. Surgical options are discussed below.

Chronic instability of the subtalar joint frequently requires surgical intervention. Despite this, the treatment is initially nonsurgical and is similar to the conservative management of recurrent or chronic lateral ankle instability. This includes peroneal strengthening, proprioceptive training, Achilles tendon stretching, and the use of a brace. Taping of the ankle by an athletic trainer can be of benefit, especially when a subtalar sling modification is incorporated.


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