The vast majority of all ankle ligament injuries are managed conservatively. The only controversial area regarding the management of lateral ligament injuries involves grade three sprains. A recent Cochrane review did not find any evidence to favour surgery for these injuries.4 The evidence favours a three-month period of conservative treatment as per other ankle sprains for all levels of athlete. Syndesmosis injuries with evidence of diastasis should be managed operatively.
The prognosis following an ankle sprain is generally good. Following a lateral ligament injury, complete function can be expected in six to eight weeks. This can often be achieved much earlier with good early treatment during the acute stage. On average, injury to the deltoid ligament or syndesmosis can take twice as long to recover from. As with injuries to other body parts, the player should undergo a series of functional tests before being allowed back to football practice.
Although most patients do well, as many as 10% to 20% of the patients have persisting problems after an acute ankle injury.5 Therefore, patients should be advised to contact a doctor if they have late symptoms. Players with persistent instability symptoms should complete at least ten weeks of intensive proprioceptive training. The affected ankle should be taped or braced to prevent re-injury during this extended recovery period. If instability episodes persist, even after completion of an adequate sensorimotor training programme, the player should be referred to an orthopaedic surgeon for further evaluation and management; surgical stabilisation of the lateral ligaments may be indicated in such cases.
There is no convincing evidence to show that either taping or bracing limits the risk of injury in athletes who have never sustained an ankle sprain before. Taping and bracing following injury, however, has been shown to reduce the risk of repeat sprains.6 The damaged ligament may take a prolonged period to heal, maybe as long as a year. This means that return to play is possible before complete healing of the ligament has taken place. The effectiveness of taping is probably a proprioceptive effect rather than a mechanical effect. It is suggested that athletes tape their ankle for a 6-12 month period following their injury.