This FastFact showcases a clinical guideline which explores the diagnosis, prevention and treatment of lateral ankle sprains. It was created by a multi-disciplinary team of experts and is evidence-based1.
Ankle sprains are among the most common injuries in football. They can have significant morbidity and can be associated with recurring instability. One of the stated objectives of this clinical guideline was to review the evidence regarding prevention and to provide evidence-based recommendations for clinicians. While there are a number of important themes in the paper this FastFact focuses on prevention.
There is level one evidence showing that the use of an ankle brace or taping can reduce the risk of both recurrent and first-time lateral ankle sprains. There does not appear to be any difference in efficacy between different types of tape and/or braces and as a result a player should chose the option that best suits his needs. Kinesiotape, which is currently very fashionable, may also have a preventive effect in patients who have already sustained an ankle sprain. Comfort and cost are important considerations when choosing or prescribing this treatment. There do not appear to be any meaningful negative effects with this approach.
Exercise therapy, including ankle strengthening exercises (especially the peronei), coordination and balance training are important preventative strategies. This is especially important when the player has had recurring sprains. Rehabilitation should be started as soon as possible after the initial sprain to prevent recurrent lateral ankle sprain (LAS). When possible it should be included in regular training activities and combined with home-based exercise. The preventive effect of exercise therapy for first-time ankle sprains has not been proven.
There is a current trend for players to wear high top boots (with a built in sock). Some of the marketing for these products has suggested that wearing them may help prevent injury. This is in contrast to the data however as there is currently no evidence that shows that footwear type impacts the risk of injury (three RCTs, n=3410).
It is always important to recognise that the absence of evidence does not mean that a treatment does not work. Taking a pragmatic approach to the prevention of ankle sprains it would appear that strengthening and balance training are key, that ankle taping or bracing is important and that players should chose footwear that they find comfortable.
1Vuurberg G Hoorntje A, Wink L M et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018;52:956. doi:10.1136/bjsports-2017-098106