Ankle sprains
Authors: Roosen Philip , Willems Tine , De Ridder Roel , San Miguel Lorena , Holdt Henningsen Kirsten , Paulus Dominique , De Sutter An , Jonckheer Pascale 
Published: January 2025

SCIENTIFIC REPORT 7 -- 1 -- INTRODUCTION 7 -- 1.1 ANKLE SPRAIN: A FREQUENT PROBLEM 7 -- 1.2 CONTROVERSIES ON THE N EED FOR RADIOGRAPHY 7 -- 1.3 OBJECTIVE OF THIS REPORT 8 -- 1.4 ANATOMY AND CLASSIFICATION OF ANKLE SPRAINS 8 -- 1.4.1 Anatomy of the ankle 8 -- 1.4.2 Ligaments hit in ankle sprains . 8 -- 1.4.3 Classification of ankle sprains .. 9 -- 2 SCOPE 10 -- 3 METHODOLOGY 10 -- 3.1 STAKEHOLDER AND EXPERT INVOLVEMENT 10 -- 3.1.1 Stakeholders 10 -- 3.1.2 Experts 12 -- 3.2 CLINICAL QUESTIONS 12 -- 3.2.1 General questions 12 -- 3.2.2 Specific questions 12 -- 3.3 LITERATURE REVIEW 13 -- 3.3.1 Participants 13 -- 3.3.2 Intervention 13 -- 3.3.3 Comparator 13 -- 3.3.4 Outcome 13 -- 3.3.5 Study design 13 -- 3.3.6 Databases and date limits .14 -- 3.3.7 Search strategy .. 14 -- 3.3.8 Quality appraisal 17 -- 3.3.9 Data extraction 17 -- 3.4 ELABORATION OF RECOMMENDATION 19 -- 3.5 VALIDATION AND UPDATING THE GUIDELINE 20 -- 3.5.1 Validation process 20 -- 3.5.2 Updating of the guideline 20 -- 3.6 FUNDING AND DECLARATION OF INTEREST 20 -- 4 RESULTS FOR DIAGNOSIS 21 -- 4.1 HISTORY TAKING 21 -- 4.2 PHYSICAL EXAMINATION (OTTAWA ANKLE RULES EXCEPTED) 22 -- 4.2.1 Inspection and palpation 22 -- 4.2.2 Functional tests .. 22 -- 4.2.3 Timing of clinical examinations 23 -- 4.3 PHYSICAL EXAMINATION: OTTAWA ANKLE RULES (AND DERIVED) 24 -- 4.3.1 Description of the Ottawa ankle rules 24 -- 4.3.2 Validity of the Ottawa Ankle Rules 25 -- 4.3.3 Validity of other decision tools: tuning fork test, Bernese ankle rules, Leiden ankle rules and Utrecht ankle rules 27 -- 4.3.4 Implementation of the Ottawa ankle rules .. 29 -- 4.4 IMAGING 31 -- 4.4.1X-ray 31 -- 4.4.2 Ultrasonography 31 -- 4.4.3 Magnetic Resonance Imaging 32 -- 4.4.4 Computer assisted tomography .. 33 -- 4.5 DISCUSSION: DIAGNOSIS OF ANKLE SPRAIN 33 -- 4.6 RECOMMENDATIONS CONCERNING THE DIAGNOSIS OF ANKLE SPRAIN 35 -- 5 ALGORITHM FOR DIAGNOSIS 37 -- 6 RESULTS FOR THERAPY 38 -- 6.1 DRUG THERAPY 38 -- 6.1.1 Analgesic and anti-inflammatory oral medication 38 -- 6.1.2 Venotonic drugs 42 -- 6.1.3 Topical non-steroidal anti-inflammatory drugs (NSAIDs) 42 -- 6.1.4 Alternative topical therapies: Comfrey (Symphytum officinale) root extract ointment (consoude). 45 -- 6.2 REST, ICE, COMPRESSION AND ELEVATION 45 -- 6.2.1Rest versus mobilisation 46 -- 6.2.2 Ice versus no ice. 46 -- 6.2.3 Compression versus compression: intermittent pneumatic compression versus elastic bandage. 47 -- 6.2.4 Elevation versus no elevation 47 -- 6.2.5 RICE versus no RICE 47 -- 6.3 ELECTROPHYSICAL THERAPY 47 -- 6.3.1 Ultrasound 47 -- 6.3.2 Laser therapy 48 -- 6.4 ANKLE SUPPORT .. 49 -- 6.4.1 Immobilisation devices 49 -- 6.4.2 Support allowing partial mobilisation 50 -- 6.5 MANUAL THERAPY 51 -- 6.6 EXERCISE THERAPY 51 -- 6.7 OTHER CONSERVATIVE TREATMENTS 52 -- 6.7.1 Hyperbaric oxygen 52 -- 6.7.2 Proteolytic enzyme 52 -- 6.7.3 Hyaluronic acid intra-articular injections 53 -- 6.8 SURGICAL TREATMENT 53 -- 6.9 DISCUSSION: THERAPY FOR ACUTE LATERAL ANKLE SPRAIN 53 -- 6.10 RECOMMENDATIONS CONCERNING THE THERAPY OF ANKLE SPRAIN 55 -- 7 ALGORITHM FOR THERAPY 58 -- 8 IMPLEMENTATION OF THE GUIDELINE 59 -- 8.1 AT PRACTICE LEVEL: ADAPTATION TO INDIVIDUAL SITUATIONS. 59 -- 8.2 IMPLEMENTATION BY PROFESSIONAL SOCIETIES 59 -- 8.3 MONITORING THE GUIDELINE DISSEMINATION 59 -- 8.4 MONITORING THE GUIDELINE IMPLEMENTATION.59 -- REFERENCE LIST 60 -- APPENDICES 68