Trends in the Management of Lateral Ankle Sprains in the United States

MA, Glavniano NR, Donavan L, Hart JM, Saliba SA, Park JS, & Hertel J. Clin J Sport Med. 2017; 27:145-152.
doi: 10.1097/JSM.0000000000000321

Take Home Message: Most common care after an ankle sprain
involved multiple physician visits. Very few patients receive supervised

Lateral ankle sprains are one of the
most common acute injuries among physically active individuals.  Ankle sprains cause short-term pain and
disability and may cause long-term chronic ankle instability and joint damage.  Therefore, the question remains as to how
ankle sprains are managed and whether the deficits exist due to initial
management or if they develop after recovery from the primary injury.  The authors of this study aimed to describe lateral
ankle sprain management within 30 day of injury using a database of national
health insurance records in the United States for 2007 to 2011.  Specifically, they focused on diagnosis codes
for lateral ankle sprains and excluded people with concurrent fractures, medial
sprains, or syndesmotic sprains. Next, the authors evaluated the database to
determine how often patients received diagnostic imaging, orthopedic devices,
or physical therapy treatments within 30 days of the injury. Overall, 96% (~740,000
injuries) of documented ankle sprains were lateral ankle sprains without foot
or ankle fracture.  Two-thirds of them
received an ankle x-ray. On average patients with an ankle sprain attended of a
little over 4 physician’s visits for each injury.  Less than 7% of patients who suffered a
lateral ankle sprain were referred for supervised rehabilitations. Physician
visits in addition to the resulting imaging, care, rehabilitation accounted for
approximately $152 million in health care costs within the database. Of these
costs $124 million were because of physician visits. 

While it may seem that a lateral
ankle sprain can be managed conservatively with home exercise programs or
patient education, the vast majority of patients are never referred to supervised
rehabilitation. This may contribute to chronic ankle instability post ankle
sprain.  While returning to normal
activities of daily living is successful, the long-term risk of instability should
cause us to pay closer attention to the importance of supervised rehabilitation
programs.  There were some patients who
saw a physical therapist for evaluation, treatment, and rehabilitation.  It is unknown how access to an athletic
trainer may affect these numbers.  It
would be interesting to see how the financial burden of ankle sprains vary now
in comparison to the investigated time (2007 to 2011) when the physician visits
were the most expensive component of care. 
Healthcare has shifted and allows more direct access visits to physical
therapists.  While only a small number of
patients went to physical therapy, it would be interesting to see how patient-reported
outcomes, recovery times, costs, and reinjury rates compare between those who
did and did not complete supervised rehabilitation.  Considering the consequences of poor
long-term outcomes, we need to re-evaluate our current treatment paradigm and seek
solutions to prevent poor long-term outcomes. The largest focus may need to be
on ensuring that our patients receive a supervised rehabilitation program to
address their short-term issues and reduce the long-term risks of chronic ankle
instability and post-traumatic osteoarthritis. Patient education may also be
essential in the performance of maintenance programs or exercises to try to
prevent another injury from occurring or from developing these long-term

for Discussion:  What do you use for post-lateral
ankle sprain functional testing to determine clearance?  Are there any areas that you pay specifically
attention to when a patient is recovering from a lateral ankle sprain?

by: Nicole Cattano
by: Jeffrey Driban


Feger, M., Glaviano, N., Donovan, L., Hart, J., Saliba, S., Park, J., & Hertel, J. (2017). Current Trends in the Management of Lateral Ankle Sprain in the United States Clinical Journal of Sport Medicine, 27 (2), 145-152 DOI: 10.1097/JSM.0000000000000321