Non-operative management of lateral ligament injuries is generally recommended, even if there is evidence of a combined injury to the anterior talofibular and calcaneofibular ligaments. In most cases, functional treatment provides the quickest recovery of full range of motion and return to play, does not compromise mechanical stability any more than other treatments, and is safer and less expensive. Surgery is therefore not indicated as the primary treatment of uncomplicated ankle sprains.
- Acute treatment
- The goals of a functional treatment programme are to minimise the symptoms associated with the initial injury. Limiting the swelling and pain will permit early restoration of range of motion, muscle strength and neuromuscular control. A sport-specific exercise programme follows before a full return to training and competition. Analgesics can be used to provide pain relief, but acetylsalicylic acid (aspirin) and other non-steroidal anti-inflammatory medications can prolong bleeding and should be avoided if possible. Simple analgesia is useful and may accelerate recovery by permitting earlier achievement of full active range of motion and weight-bearing, resulting in an earlier return to training and competition.
During the rehabilitation period, it is important to protect the ankle from new injury. Taping or bracing the ankle can help with this. Once the acute pain and swelling have settled, a training programme to improve balance and peroneal strength can be very effective.
- Rehabilitation programme
- After the initial bleeding phase is over, the goal of treatment is to regain normal, pain-free range of motion. Increased range of motion can be achieved through passive, active or active-assisted stretching exercises as well as by submaximal exercise on a stationary bike. The exercise programme should progress (according to the improvement in function and degree of symptoms) from progressive linear movements (e.g. toe-raises, squats, jogging, jumping in place on two legs, then one, skipping-rope jumping) to cutting movements (e.g. running figures of eight, sideways jumping, sideways hurdle jumps). The goal of this progression of exercises is to gradually progress towards sport-specific exercises.
An important goal in the successful rehabilitation of an ankle sprain injury is the re-establishment of neuromuscular control of the ankle through a programme of balance exercises. Proprioceptive function is impaired in patients with residual functional instability after previous sprains, which can be improved by balance board exercises.
Peroneal strengthening exercises are also an important part of the rehabilitation programme. These should be done with the ankle in a plantar-flexed position. The ankle is least stable in plantar flexion – and this is the position where more ankle inversion injuries occur.
Such programmes can reduce the risk of re-injury to the level of a previously uninjured ankle. Neuromuscular training should be carried out for six to ten weeks after an acute injury.