This is an updated international evidence-based guideline on diagnosing, treating and preventing acute lateral ankle sprain. It pools data from 194 studies to standardize care across primary and secondary settings. It addresses risk factors, diagnostic rules, treatment modalities, prevention strategies, and cost-effectiveness.
Treat the acute sprain functionally: a brace plus early exercise, not a cast. A 4-week cast produces worse outcomes than functional support, and if you immobilize for pain or swelling at all, keep it under 10 days. When you need to grade ligament damage, re-examine at 4–5 days rather than in the swollen acute ankle, when the anterior drawer reaches 84% sensitivity and 96% specificity.
Use the Ottawa Ankle Rules up front to avoid needless radiographs, since only 15% of these patients actually have a fracture. For prevention, bracing has the strongest recurrence data (RR 0.30) and proprioceptive exercise cuts recurrence (RR 0.62), so build both into the rehab plan, especially for athletes.
Reserve surgery for patients who fail comprehensive exercise-based treatment or professional athletes needing fast return, because surgery carries about 5-fold more complications and most patients recover without it.
This is an updated international evidence-based guideline on diagnosing, treating and preventing acute lateral ankle sprain. It pools data from 194 studies to standardize care across primary and secondary settings. It addresses risk factors, diagnostic rules, treatment modalities, prevention strategies, and cost-effectiveness.
Treat the acute sprain functionally: a brace plus early exercise, not a cast. A 4-week cast produces worse outcomes than functional support, and if you immobilize for pain or swelling at all, keep it under 10 days. When you need to grade ligament damage, re-examine at 4–5 days rather than in the swollen acute ankle, when the anterior drawer reaches 84% sensitivity and 96% specificity.
Use the Ottawa Ankle Rules up front to avoid needless radiographs, since only 15% of these patients actually have a fracture. For prevention, bracing has the strongest recurrence data (RR 0.30) and proprioceptive exercise cuts recurrence (RR 0.62), so build both into the rehab plan, especially for athletes.
Reserve surgery for patients who fail comprehensive exercise-based treatment or professional athletes needing fast return, because surgery carries about 5-fold more complications and most patients recover without it.