A Walk Through Time Shows Best Treatments for Ankle Sprains

Even though sprains of the outer (lateral) ankle ligaments are one of the more common types of injuries, opinions abound as to the best types of treatment. Over the years, treatments have ranged all the way from surgery to no treatment at all. Which treatments are best? To answer this question, the authors analyzed research articles spanning the years 1966 to 1998. In general, treatment options for lateral ankle sprains include surgery, casting for more than six weeks, or functional treatment. The authors also compared cases where patients had functional training or a cast after surgery. Time off work was one way to measure if the treatment was helpful. But the authors concluded that a more accurate test is whether patients had episodes of unsteadiness in the ankle, a condition called give-way. Give-way happens when a joint has become loose, either because the ligaments are unable to support the joint, or because the nerves that give sensations for position have been harmed. Results of the analysis showed that people treated surgically had fewer problems with give-way compared to those who had functional training. People with functional training had fewer problems with give-way than those who were casted. Pain was nearly the same in patients who had surgery and those who had functional training. However, people who had minimal or no treatment had significantly more pain in the long-term than either of the other groups. Also, patients who had surgery did better if they had functional training afterward instead of a cast. Even though surgery showed better results overall, the authors caution that surgery poses higher risks and costs. However, they concluded that surgery is a reasonable choice if functional treatment alone hasn’t helped.