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Structured clinical assessment: a brake to stop the ankle joint ‘rolling’
  1. Eamonn Delahunt1,2,
  2. Phillip A Gribble3
  1. 1 School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
  2. 2 Institute for Sport & Health, University College Dublin, Dublin, Ireland
  3. 3 College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Eamonn Delahunt, School of Public Health, Physiotherapy & Sports Science, University College Dublin, Health Science Centre, Belfield, Dublin 4, Ireland; eamonn.delahunt{at}ucd.ie

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Lateral ankle sprains are the most prevalent lower limb musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities.1 2 The prevalence of lateral ankle sprains is also high among the general population and hence, the ‘simple ankle sprain’ constitutes a substantial healthcare burden.1 2

It is not just a ‘simple ankle sprain’

The misconception that acute lateral ankle sprains are benign injuries pervades clinical practice across many healthcare disciplines. Colloquial terms such as a ‘rolled’ ankle or ‘twisted’ ankle are commonly used to describe an acute lateral ankle sprain injury. Up to 50% of individuals who incur an acute lateral ankle sprain do not seek formal healthcare management for their injury.3

In reality, there is no such thing as a ‘simple ankle sprain’.4 This is evidenced by the high propensity for the development of long-term injury-associated symptoms such as persistent swelling and pain. Other symptoms include a subjective reporting of ankle joint instability, as well as ‘giving-way’ of the ankle joint which, along with recurrent lateral ankle sprain injuries, constitute the characteristic features of chronic ankle instability.5–8 As many as 40% of individuals who incur a first-time lateral ankle sprain injury can be expected to develop chronic ankle instability as early as 12 months after their injury.9

Suboptimal treatment for acute lateral ankle sprain injuries

A large percentage of all injury patients visiting emergency departments have incurred a lateral ankle sprain injury. Many UK emergency departments favour a passive approach by recommending rest, ice, compression, elevation and non-steroidal anti-inflammatory drugs; physiotherapy is recommended only in selected cases with little standardised criteria informing this decision.10 In US emergency departments, fewer than 7% of patients receive physical therapy within 30 days of incurring an acute lateral ankle sprain injury.11 The priority in many emergency departments is limited to advice on controlling acute inflammatory symptoms.

Discharge criteria after acute lateral ankle sprain injury are often vague and avoid prognostication relating to recovery. High school athletes are oftentimes sanctioned to return unrestricted (ie, no taping, no bracing and no exercise-based rehabilitation) to sports participation within 1–7 days postinjury.12 Given the twofold increased risk of reinjury in the 1-year time period following an acute lateral ankle sprain injury,13 current management strategies for these injuries are woefully inadequate based on the high-risk for reinjury and development of chronic ankle instability.

Clinical assessment: a brake to stop the ankle joint ‘rolling

The interaction of injury-related mechanical and sensorimotor impairments promote the development of chronic ankle instability.6–8 Clinicians may fail to fully understand the full spectrum of mechanical and sensorimotor impairments that manifest following an acute lateral ankle sprain injury.14 Consequently, it is logical to conclude that the treatment being administered following acute lateral ankle sprain injury is unlikely to be based on objectively identified mechanical and sensorimotor impairments.

To address this limitation, we propose that a structured clinical assessment following acute lateral ankle sprain injury that assesses both mechanical and sensorimotor impairments is an imperative first step towards the development of an appropriate management pathway. It will allow clinicians to focus the design and progression of treatment/rehabilitation programmes around objectively identified impairments.

To initiate this imperative first step towards the development of an appropriate management pathway for acute lateral ankle sprain injuries, we undertook an international multidisciplinary modified Delphi process.15 This modified Delphi process informed the development of a consensus statement on a structured clinical assessment for acute lateral ankle sprain injuries. Our Delphi process has resulted in the development of a pragmatic minimum standard clinical diagnostic assessment, as well as an initial rehabilitation-oriented assessment.16 The primary focus of the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST) is to help clinicians identify the primary mechanical and/or sensorimotor impairments that have been commonly observed in individuals with chronic ankle instability.

This 2018 consensus statement from the International Ankle Consortium15 will be a key resource for clinicians who regularly assess and treat individuals who have incurred an acute lateral ankle sprain injury. We propose that the International Ankle Consortium ROAST outlined in the consensus statement could provide the brake to stop the ankle joint ‘rolling’.

References

Footnotes

  • Contributors Both authors have made substantial contributions to this editorial. They both participated in the concept and drafting and revising the manuscript. Both authors have read the manuscript and agreed to submission for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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