Casting a Severe Ankle Sprain Yields Better Results!

Alert the Media! A below knee cast was seen to provide better and faster results than a removable walking cast or ace bandage in severe ankle sprains! Duh! You can't take off a cast and it forces you to be compliant. Most of our patients want to be compliant but life gets in the way. Ten days in a cast rapidly improves short term outcomes......what will they report next? That physical therapy imporves long-term outcomes? Who funds these studies? Can I get some of their money to prove common sense? Just kidding......

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Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.

Short version:

Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.


The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.


The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.


The quality of recovery at nine months did not differ among the four devices.

"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."


"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."


Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.

For more information on the treatment of ankle sprains, click here