Culture Sports Medicine

The Answer for Severe Ankle Sprains: Put A Cast On It (repost 2009)

Dancing to the tune of “Put A Ring On It” you get carried away and find that you’ve tripped over an object lying on the carpet. Or more likely, you’ve stepped in a hole, stepped wrong coming down stairs or twisted your ankle on an uneven trail while running. Of course basketball is especially known for a notoriously¬† high number of ankle spains.

Once it is determined that it ranks as “bad” what should you do? The Lancet compared a Bledsoe boot, Aircast Splint, Circular Wrap, and a plaster cast as treatment for “bad” ankle sprains and found the cast best, followed by the AirSplint. “Bad” sprains were Grade III which includes complete tear of a ligament. The assessment included an x-ray, since the patients included were unable to bear weight on the ankle. The Ottawa Criteria were used.

The conclusion was that in this group, the casting was superior to the other methods of treatment. The duration of cast use was 10 days. The investigators noted other studies have used time periods of up to 6 weeks, and the exact time needed to assist healing is not known. Noted also was the possibility of long term and even permanent injury resulting from an ankle sprain.

In my office, I have long used the AirSplint Pneumatic Walker for this condition with good results. The authors of the Lancet study noted that in some cases the ankle sprains resulted in long term, and occasional permanent injury. Rehabilitation methods were not compared and studied. A podcast interview with the lead author was interesting. Citations of animal studies indicating improved healing with motion were noted. But the author felt that they would all change their clinical practice based on their study. Happily I have treated humans, not rabits, and learned from it. I’ve been using similar therapy for a long time, and don’t need to make dramatic adjustments. The lesson here though, could be for emergency rooms around the globe to learn more about and improve their treatment of ankle sprains. Bad treatment has led to the saying “a sprain is worse than a break”. With appropriate treatment, rehabilitation, and follow up. It doesn’t have to be so.

For more general information on ankle sprains see: Dr. Pribut on Ankle Sprains

Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomised controlled trial S E Lamb, J L Marsh, J L Hutton, R Nakash, M W Cooke,
The Lancet, Volume 373, Issue 9663, Pages 575 – 581, 14 February 2009. Article Direct Link

Reblog this post [with Zemanta]