Maggie Fournier, DPM, FACFAS addressed ankle sprain treatment at the Midwest Podiatry Conference. She poses the following questions: why are there so many variations in treatment, and, what does the current evidence say?

After reviewing key anatomic and pathologic features of ankle sprains, Dr. Fournier shares that the physical exam for lateral ankle sprains is most ideal 4 to 5 days after initial injury. She says that this timing, in her experience, allows for the exam, including stress maneuvers, to have less impact from edema and guarding, making it more precise and reliable. She goes on to review best practices in imaging and diagnostics.

Dr. Fournier shares that many clinicians find ankle sprain grading systems vague and confusing. She says that she gathers all of the information from her physical examination, including functional loss at time of presentation, in order to best determine grading. Treatment is then guided by this grading. She stresses that patient education is key, especially regarding expectations. Dr. Fournier goes to on advocate for a conservative approach over surgery for any grading in the acute setting, as she cites comparable long-term outcomes, a non-invasive approach, and lower complication risk.

Regarding these conservative treatment options, she says that rest, ice, compression, and elevation (RICE) is a good start, and that functional immobilization is preferable to prolonged full immobilization. She discussed the advantages of functional bracing, including that there is no evidence that long-term use of bracing leads to weakness. Structured early physical therapy shows evidence of improved healing and better patient adherence compared to self-directed therapy and exercises. Lastly, she discussed the role of medications, including avoidance of cortisosteroid injection.