SLR - January 2022 - Alex J. Bischoff
Reference: Raeder C, Tennler J, Praetorius A, Ohmann T, Schoepp C. Delayed Functional Therapy After Acute Lateral Ankle Sprain Increases Subjective Ankle Instability – The Later, The Worse: A Retrospective Analysis. BMC Sports Sci, Med Rehabil. 2021 Aug 6;13(1):86.Level of Evidence: 3
Scientific Literature Review
Reviewed By: Alex J. Bischoff, DPM
Residency Program: Grant Medical Center – Columbus, OH
Podiatric Relevance: Lateral ankle sprains (LAS) are one of the most common injuries seen by podiatric physicians. There are multiple evidence-based treatment modalities which are often used, including ankle bracing, immobilization, compression, and early mobilization. However, these injuries are frequently perceived as minor and treatment modalities are inadequate. This can in-turn lead to an increased risk of re-injury and eventually lead to chronic ankle instability (CAI). In that light, the purpose of this study was to determine the rate of CAI and identify modifiable contributing factors for developing instability following an acute ankle sprain to reduce risk.
Methods: The database of the BG Klinikum Duisburg, Germany was retrospectively reviewed. The diagnostic code “sprain of ankle” was applied to identify relevant cases over a three-year period (2015-2018). To be included in the study patients had to be between the ages of 14 and 55 years and have no accompanying boney injuries.
One thousand four hundred seventy-eight (1,748) cases met this inclusion criteria. These patients were then sent a postal questionnaire or contacted via telephone to complete a questionnaire. A total of 647 completed the survey and were included in the study. Gender and age information was obtained. Patient reported outcomes measures including the Tegner-Score, Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index (FADI) were recorded. According to pre-defined guidelines, a CAIT < 24 indicated a patient has CAI. Patients were also asked about the modality of therapy received and the timing of the beginning of therapy (i.e., immediate start, 1-4 weeks, > 4 weeks). Descriptive statistics were obtained utilizing Mann Whitney U tests, independent t-tests, and ANOVA systems.
Results: The overall CAI rate was 17.3 percent in patients who experienced a LAS. Females over 41 years of age were more affected than males in the same age group. Frequency of LAS were highest in younger age groups (14-25 years) and gradually decreased with advancing age. The FADI score was significantly higher in patients without CAI compared to those with CAI (97.7 vs. 80.2). As expected, there was a significantly higher CAIT score, and thus a lower rate of CAI, in those who did not have any recurrent ankle sprain compared to those who had recurrent sprains. There was a statistically significant improvement in CAIT score in those who had an immediate start to functional therapy compared to those who waited longer than four weeks to initiate functional therapy. However, there was no significant difference in the CAIT score between the differing functional therapy modalities.
Conclusions: This article is valuable in providing research-based recommendations for immediate start to functional therapy following LAS. Beginning functional therapy early appears to be an effective modifiable means to prevent chronic ankle instability, which will in turn improve overall functionality. Functional therapy should focus on the domains of range of motion, strength, postural control, and functional tasks. The exact modality utilized is of lesser importance than the timing of the therapy. This is especially important for females and younger patients, both of which appear to be more prone to LAS. Based on the findings in this study, Podiatric physicians should encourage immediate functional therapy following acute lateral ankle sprains.