Ankle sprain: immobilisation is best treatment
20 February 2009
A period of immobilisation with a below-knee cast leads to speedier recovery than other treatments for severe ankle sprain.
The latest findings call into question current practices promoting aggressive functional treatment. (Functional treatments support, rather than immobilise, the ankle and include tapes and bandages.)
The UK multicentre, randomised controlled trial compared double-layer tubular compression bandaging with 3 other mechanical support treatments — a 10-day below-knee cast, Bledsoe boot or Aircast brace — among 584 patients with severe, predominantly recurrent ankle sprains (Lancet 2009; 373: 575-81).
After 3 months, those randomised to receive the below-knee cast had a 9 per cent greater improvement in ankle function compared to those receiving a compression bandage. They also reported greater improvements in pain, symptoms and activity.
People using the Aircast brace had an 8 per cent improvement in ankle function compared to those treated with compression bandages, but there was little difference in pain, symptoms and activity.
Bledsoe boots offered no benefit over compression bandaging, leading the authors to recommend against either of these treatments.
‘Contrary to popular clinical opinion, a period of immobilisation was the most effective strategy for promoting rapid recovery,’ the authors said.
Tubular compression bandaging, ‘which is the most commonly used of all the supports investigated, was consistently the worst treatment,’ they added.
Last Reviewed: 20 February 2009
- 1. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW. Collaborative Ankle Support Trial (CAST Group). Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet 2009; 373: 575-81
