Splints for a sprained ankle
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Information, in part, from the American Physical Therapy Association
A sprained ankle is classified according to severity.
The following classification system is frequently used:
First degree ankle sprain:
Some stretching or mild tearing of the ligament.
Little or no functional loss - the joint can still function and bear some weight.
Some joint stiffness.
Second degree ankle sprain:
More severe tearing of the ligaments
Moderate instability of the joint
Moderate to severe pain – weight bearing is very painful
Swelling and stiffness
Third degree ankle sprain:
Total rupture of a ligament - there is a loss of motion
Gross instability of the joint - joint function is lost
For all grades of ankle sprain, following the R.I.C.E. principle is wise:
-Rest the ankle - no weight-bearing.
-Ice - this helps to keep the swelling down. Use ice on the injury several times a day for 15-20 minutes (more than 20 minutes is not advised). Keep a towel between the ice and skin.
-Compressive bandages to immobilize the ankle sprain and to support the injury.
-Elevate the ankle above the heart for 48 hours.
If the sprain is a 2nd or 3rd degree ankle sprain, seek out an orthopedist immediately.
If the ankle sprain is a 2nd degree sprain, in addition to the R.I.C.E. principle, a more effective means of immobilizing the ankle (splints) may be needed. Anti-inflammatory medication may also be used to help.
If the ankle sprain is a 3rd degree sprain, cast immobilization is needed for at least 2-3 weeks. Surgery to repair the ruptured ligament is often needed.
Physical therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over.
As soon as treatment is instituted, consideration must be given to adequate rehabilitation:
- exercises to increase proprioception
- ankle braces and strapping to facilitate activity
- muscle strengthening and flexibility exercises
- gradual return to any sporting activities
- maintain fitness by doing alternative activities
Exercises after the first 48 hours play a major role in the in the rehabilitation of the sprained ankle and the prevent of ankle sprains.
• Range of motion exercises
Initially, start by using a towel to gently pull the foot in dorsiflexion. Repeat this several times a day, Later use calf muscle stretches against the wall.
Initially, start by balancing on one foot - hold for as long as possible - repeat several times a day. Later a 'wobble' board can be used.
Initially start by pushing the foot outward against a wall. Hold for 3 seconds - repeat 20 times, several times a day. Later use an elastic band that is tied to a heavy object and move the foot outward against this.
The choice for treatment will depend upon the patient and their usual activities. Issues such as work duties, athletic involvement, and social activities must all be considered.
If a patient participates in a unidirectional sport such as running, an ankle brace can help but is sometimes annoying.
Another option for a runner to consider is an arch support (orthotic). The orthotic would be modified to control the lateral rotation of the patient's foot and help to center the body weight directly over the foot. An orthotic can be an excellent tool for the chronic ankle sprainer who is a runner. Orthotics may also be used for street shoes.
Patients who are involved in bi-directional sports like tennis, soccer, or racquetball need an ankle brace. The side to side forces are too great for an orthotic to overcome.
There are many varieties of splints and braces on the market today. Stirrup braces are helpful in the acute phase of ankle sprains to help control edema. Newer models also help with biomechanics. They may be too cumbersome for competitive athletes.
Lace up braces, especially those that will fit inside a shoe may be a better alternative for chronic sprains. Lace up braces ensure that the brace and shoe work together to support and protect the ankle.
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