Patients with grade I or II ankle injuries respond well to conservative treatment.10,19 A functional treatment protocol is initiated that consists of several phases (Table 66-3). Treatment immediately following the injury consists of RICE (rest, ice, compression, and elevation) with the goal to reduce swelling, hemorrhage, and pain.
During the 1- to 3-week period (proliferation phase), protection in the form of taping or bracing should be used. Weight bearing should be initiated as soon as it is tolerated as it is considered beneficial to the healing process.
At approximately 3 weeks following injury, ankle mobilization is initiated through gentle range-of-motion and controlled stretching. When pain-free range of motion and weight bearing have been established, strengthening and proprioception training can begin; timing of this varies depending on severity of the injury.
Multiple studies have compared functional treatment/early protected mobilization with both cast immobilization and acute surgical repair (including a large meta-analysis by Kannus and Renstrom20). Functional treatment results in a more rapid recovery of ankle mobility and an earlier return to work or physical activity without sacrificing mechanical stability.21,22 Additionally, if a patient does fail initial nonoperative treatment, delayed reconstruction can be performed even several years following the injury with comparable results to primary repair.
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