Sprained Ankle - 4

Important The Ottowa Ankle Rules can save time, money and radiation - learn them.   

 Should I X-ray the ankle, or the foot or both ?

If you are considering asking for X-rays on both, this generally implies that you have not examined the patient properly.

Patients with fractures of both ankle and foot are very rare from minor trauma.

If in doubt, ask someone more senior to examine the patient, or just X-ray the most painful part, and then review.    

What treatment helps sprained ankles ?

The traditional treatment has the mnemonic RICE:
- Rest,
- Ice,
- Compression,
- Elevation.    

Rest is necessary as the ankle will often be painful to walk on.
Ask about the patient's work. Patients whose job involves being on their feet all day will need more time off.
Do not encourage the patient to take a lot of time off. From the studies, the average is two days off work, but note that some people took a month or more to get back to work.    

Ice has been shown to be helpful during the first 24 hours after an acute injury.
The ice should not be applied directly to the skin. A good technique is to put ice into a plastic bag, which is then tied and then wrapped with a cloth or towel.    

Routine use of compression bandages or compression stocking material has not been shown to be helpful.
Patients who believe in the healing properties of such bandages may wish to purchase them from a pharmacy.    

The patient should aim to keep the leg elevated to at least the level of the pelvis when they are sitting down.
The aim is to reduce swelling.    

Crutches should be offered to adults and older (more than 8 years old) who cannot weight bear. Younger children find it difficult to use crutches properly.
Patients should be fitted with correctly adjusted crutches, and instructed in how to use them, and their understanding should be checked.    

When should I put the sprained ankle in a plaster ?

If the sprain is bad, and the patient cannot weight bear at all, they are not going to be able to use the ankle anyway.

Putting it in a backslab plaster makes sure that the patient rests it properly, and also makes sure that if there is a fracture that you have missed, it is being treated appropriately.

These patients should be reviewed by their GP or in fracture clinic in a week, with the plaster removed. Patients who are still very tender should have repeat X-rays.