Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains

Muhammad Naeem, Muhammad Kazim Rahimnajjad, Nasir Ali Rahimnajjad, Zaki Idrees, Ghazanfar Ali Shah, Ghulam Abbas, Muhammad Naeem, Muhammad Kazim Rahimnajjad, Nasir Ali Rahimnajjad, Zaki Idrees, Ghazanfar Ali Shah, Ghulam Abbas

Abstract

Background: Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures.

Materials and methods: 126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance.

Results: 60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group.

Conclusion: The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast.

Level of evidence: Level I.

Trial registration: ClinicalTrials.gov NCT01499966.

Figures

Fig. 1
Fig. 1
CONSORT diagram

References

    1. Fong DTP, Chan YY, Mok KM, Yung PSH, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:14. doi: 10.1186/1758-2555-1-14.
    1. Lamb SE, Nakash RA, Withers EJ, clark M, Marsh JL, Wilson S et al (2005) Clinical and cost effectiveness of mechanical support for severe ankle sprains: design of a randomised controlled trial in the emergency department. BMC Musculoskelet Disord 6:1
    1. Wedmore IS, Charette J. Emergency department evaluation and treatment of ankle and foot injuries. Emerg Med Clin North Am. 2000;18:85–113. doi: 10.1016/S0733-8627(05)70109-7.
    1. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician. 2001;63:93–104.
    1. Ellen K, Van de Port I, Frank B, van Dijk Niek. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Sports Med. 2011;41:185–197. doi: 10.2165/11584370-000000000-00000.
    1. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, Niek van Dijk C. Immobilisation for acute ankle sprain—a systematic review. Arch Orthop Trauma Surg. 2001;121:462–471. doi: 10.1007/s004020100283.
    1. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW, CAST Group Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet. 2009;373:575–581. doi: 10.1016/S0140-6736(09)60206-3.
    1. Cooke MW, Lamb SE, Marsh J, Dale J (2003) A survey of current consultant practice of treatment of severe ankle sprains in emergency departments in the United Kingdom. Emerg Med J 20:505–507
    1. Klenerman L. The management of sprained ankle. Br J Bone Jt Surg. 1998;80:11–12. doi: 10.1302/0301-620X.80B1.8037.
    1. Povacz P, Salzburg M, Unger F, et al. A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle. J Bone Jt Surg. 1998;80:345–351. doi: 10.1302/0301-620X.80B2.8032.
    1. Boyce SH, Quigley MA, Campbell S. Management of ankle sprains: a randomized controlled trial of the treatment of inversion injuries using an elastic support bandage or an air cast ankle brace. Br J Sports Med. 2005;39:91–96. doi: 10.1136/bjsm.2003.009233.
    1. Ogilvie-Harris DJ, Gilbart M. Treatment modalities for soft tissue injuries of the ankle: a critical review. Clin J Sport Med. 1995;5:175–186. doi: 10.1097/00042752-199507000-00008.
    1. Waterman BR, Owens BD, Davey S, Zacchilli MA, Balmont PJ. The epidemiology of ankle sprains in the United States. J Bone Jt Surg Am. 2010;92:2279–2284. doi: 10.2106/JBJS.I.01537.
    1. Hosea TM, Carey CC, Harrer MF. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball. Clin Orthop. 2000;372:45–49. doi: 10.1097/00003086-200003000-00006.
    1. Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: a literature review. J Athl Train. 2000;37:376–380.
    1. Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med. 1994;22:83–88. doi: 10.1177/036354659402200115.
    1. Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull. 2011;97:105–135. doi: 10.1093/bmb/ldq028.
    1. Lyrtzis C, Papadopoulos C, Natsis K, Noussios G (2011) The effect of diclofenac sodium and paracetamol on active and passive range of motion after sprains. J Hum Sport Exerc 6:40–48
    1. Hertel J. The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. J Athl Train. 1997;32:350–358.
    1. Bleakley C, McDonough Suzanne M, MacAuley Domhnall C. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust J Physiother. 2008;54:7–20. doi: 10.1016/S0004-9514(08)70061-8.
    1. Ashton-Miller JA, Ottaviani RA, Hutchinson C, Wojtys EM. What best protects the inverted weight-bearing ankle against further inversion. Am J Sports Med. 1996;24:800–809. doi: 10.1177/036354659602400616.
    1. Uh BS, Beynnon BD, Helie BV, Alosa DM, Renstrom PA. The benefit of a single-leg strength training program for the muscles around the untrained ankle. Am J Sports Med. 2000;28:568–573.
    1. Eils E, Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc. 2001;33:1991–1998. doi: 10.1097/00005768-200112000-00003.
    1. Matsusaka N, Yokoyama S, Tsurusaki T, Inokuchi S, Okita M. Effect of ankle disk training combined with tactile stimulation to the leg and foot on functional instability of the ankle. Am J Sports Med. 2001;29:25–30.
    1. Denegar CR, Miller SJ., III Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. J Athl Train. 2002;37:430–435.
    1. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35:103–108. doi: 10.1136/bjsm.35.2.103.
    1. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the sport-stirrup orthosis. Am J Sports Med. 1994;22:601–606. doi: 10.1177/036354659402200506.
    1. Sitler MR, Ryan J, Wheeler B, et al. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball: a randomized clinical study at West Point. Am J Sports Med. 1994;22:454–461. doi: 10.1177/036354659402200404.
    1. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN (2002) Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 3:CD003762

Source: PubMed

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