Ankle sprain
Examination/investigations:
Pain in the malleolar zone?
+ Any one of:
- Bone tenderness at A
- Bone tenderness at B
- Inability to weight bear (walk 4 steps, limping accepted as weight-bearing) both immediately and in the casualty department
-> Ankle x-ray
Pain in the midfoot zone?
+ Any one of:
- Bone tenderness at C
- Bone tenderness at D
- Inability to weight bear (as above) both immediately and in the casualty department
-> Foot x-ray
Diagnosis:
Grade I (mild stretching of the ligament complex without joint instability)
Grade II (partial rupture of the ligament complex without joint instability)
Grade III (complete rupture of the ligament complex with the instability of the joint)
Management:
Advised:
PRICE self-management strategy for the first 48–72 hours after injury:
Protection: protect from further injury
Rest: avoid activity for the first 48–72 hours
Ice: apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours
Compression: with a simple elastic bandage or elasticated tubular bandage, which should be snug but not tight, to help control swelling and support the injury, removed before sleep
Elevation: keep the injured area elevated and supported on a pillow until the swelling is controlled
If a severe sprain, a short period of immobilisation can result in quicker recovery
For less severe sprains: begin flexibility (range of motion) exercises as soon as they can be tolerated without excessive pain
Referral to orthopaedics: If recovery is slower than expected, worsening or new symptoms, or symptoms are out of proportion to the mechanism of injury
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