Conservative treatment of acute lateral ankle sprains

Chronic Lateral Ankle Instability: Topical Review

Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Failure after strict rehabilitation may be an indication for surgery. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic repair can be performed when the quality of the damaged ligaments permits. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics.Level of Evidence: Level V, expert opinion.

Treatment of ankle sprain or instability in Korean medicine clinics: A protocol for a prospective multicenter observational study

Background

Korean medicine (KM), including acupuncture, has been used to treat many patients with ankle sprains in Korea. The purpose of this prospective observational study is to determine how ankle sprains are treated using KM practice and to assess the outcomes of these treatments.

Methods

We will perform a prospective observational study to include around 200 participants from KM clinics with a chief complaint of ankle sprain or ankle instability. All participants will receive individualized KM treatments which may include acupuncture, pharmacopuncture, moxibustion, cupping therapy, and herbal medicine. The participants will be assessed on the information related to both ankle discomfort using a visual analogue scale and on the participant's overall condition including quality of life.

Discussion

Through this study, we would be able to collect specific and detailed data for various treatments from actual practice, such as the characteristics of the KM treatment system for treating ankle sprains or the method of acupuncture point selection. We also expect that the results of this study based on daily clinical practice will allow other researchers to create research questions that are beneficial from a clinical, societal, and patient's perspective.

Clinical research registration

This study has been registered at the Clinical Research Information Service (CRiS) of Korea: KCT0004016.

Effect of a plaster containing DHEP and heparin in acute ankle sprains with oedema: a randomized, double-blind, placebo-controlled, clinical study

OBJECTIVE

Ankle sprains are the most frequent injuries in sport and daily life, and are usually treated with anti-inflammatory drugs or compounds that have an effect on microcirculation. The efficacy and tolerability of a novel plaster containing both diclofenac epolamine (DHEP) and heparin in the treatment of acute painful ankle sprains with oedema was investigated in a randomized, double-blind, placebo-controlled study.

RESEARCH DESIGN AND METHODS

This study, carried out in 32 French medical centres, enrolled 233 patients (148 male and 86 female, aged 18-65 years) with an ankle sprain that had occurred within the previous 48 hours. Patients were treated once daily with DHEP heparin or placebo plaster for 7 days.

MAIN OUTCOME MEASURES

Reduction in ankle joint swelling measured by submalleolar circumference was the primary efficacy endpoint; secondary endpoints were pain (at rest, in active mobilization, by passive stretch and by pressure), functional disability and global judgement of efficacy and tolerability.

RESULTS

DHEP heparin-treated patients experienced a significantly greater reduction in joint swelling compared with placebo (p = 0.005). The reduction in pain was also in favour of DHEP heparin patients, with significantly lower pain in DHEP heparin-treated than placebo-treated patients within 3 hours of the first application (p < 0.05). Only two patients in the DHEP heparin plaster group and six in the placebo group experienced minor adverse events, all of which resolved spontaneously. By design, the study was limited to a placebo-controlled comparison, and there was no test for possible selection bias (subsequently ruled out by choice of efficacy parameters and measures) that may have resulted in a baseline imbalance between patient groups.

CONCLUSIONS

Results confirm the efficacy of DHEP heparin plaster compared with placebo for the treatment of painful ankle sprain with oedema. Prompt control of pain and oedema may shorten the time to initiation of a rehabilitation programme, thus reducing the risk of ankle disability recurrence and the development of chronic injury.

Conservative management of chronic ankle instability

Chronic ankle instability is a significant cause of morbidity. There are well-documented and effective surgical options for managing this condition. However, conservative management can be a viable option in selected patients. Failure of conservative management can be an indication for surgery if morbidity warrants it. Surgery can be delayed without necessarily affecting outcome.