Acute lateral ankle sprains: from functional treatment to prevention

Ankle sprains are common in daily life and often considered to be minor injuries. The objective in this thesis was to provide more evidence on the burden and optimal management of ankle sprains in terms of the magnitude of the problem, the prognostic consequences and ways to improve treatment and prevention. Time trends (10-25 years) of ankle injuries and sprains in the population at large and treated at emergency departments (ED) were analyzed. In the past, the incidence of acute ankle sprains has often been studied in athletic cohorts solely. This may have led to an underestimation of the extent of the ankle injury problem. According to the data in our trend analysis, the incidence rates of all medically and non-medically treated ankle injuries are around 5.5 times higher than those registered at EDs, indicating that ankle sprains in ED studies only represent the tip of the iceberg. Approximately 40% of the ankle injuries are (para)medically treated. And although functional treatment is the recommended treatment for acute lateral ankle sprains for almost 25 years now, there are still controversies over the best functional treatment type. In this trial the effects of four weeks of soft bracing or taping following acute lateral ankle ligamentous sprain (ALALS) on sprain recurrence rates and residual symptoms at one year were evaluated. The CT could not bring the controversy about the best functional treatment type to a decisive close. Alongside our CT, the costs of soft ankle bracing compared to ankle tape treatment in patients with an ALALS were assessed. The costs of soft ankle bracing were lower than for ankle taping, although this difference was not statistically significant. Our study regarding long term outcomes of acute lateral ankle sprains subscribes the high percentage of patients dealing with recurrences and persistent symptoms after an ankle sprain. The results of a study regarding the proportion of patients suffering from one or more recurrent ALALS during one year follow-up after the initial injury show that the risk of ankle sprain recurrences decreases with increasing age. This highlights the importance of optimal treatment and preventive programs in younger adults, to reduce the burden from recurrent lateral ankle ligamentous sprains. Finally, several effective ankle injury preventive measures are known and most of them are very easy to apply. However, athletes do not automatically apply effective measures for secondary injury prevention. This asks for a specific behavioral change. Therefore, the use of preventive measures must be stimulated for relevant target groups, by persuading them of the benefits of applying the measures and by removing assumptions concerning negative side-effects.