ANKLE SPRAIN MANAGEMENT – 2026 EVIDENCE-BASED POSTER Dr Ramon Reyes, MD ⚕️

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🧠📊 ANKLE SPRAIN MANAGEMENT – 2026 EVIDENCE-BASED POSTER

Dr Ramon Reyes, MD ⚕️
Emergency | Tactical | Operational Medicine

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🔬 BACKGROUND

Ankle sprains are among the most frequent musculoskeletal injuries, particularly involving the lateral ligament complex (ATFL) due to inversion mechanisms. Mismanagement leads to chronic instability and recurrence.

🔗 https://www.ncbi.nlm.nih.gov/books/NBK459212/
📌 DOI: 10.1097/MD.0000000000019742

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🧬 PATHOPHYSIOLOGY

• Inversion → ATFL ± CFL injury
• Eversion → Deltoid ligament (less common)

Severity:

• Grade I → stretch
• Grade II → partial tear
• Grade III → complete rupture

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🧠 ASSESSMENT

✔ Ottawa Ankle Rules (OAR)

High-sensitivity tool to exclude fractures.

📌 DOI: 10.1136/bmj.326.7386.417
🔗 https://www.bmj.com/content/326/7386/417

Imaging if:

• Bone tenderness (malleoli/navicular/5th metatarsal)
• Inability to bear weight

👉 Sensitivity ≈ 99%

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⚡ ACUTE MANAGEMENT (0–48h)

RICE / PRICE PRINCIPLE

• Protection (brace)
• Rest (relative)
• Ice (15–20 min / 2–3h)
• Compression
• Elevation

🔗 https://www.rch.org.au/clinicalguide/guideline_index/fractures/Ankle_Sprains_-_Emergency_Department/

⚠️ Avoid prolonged immobilization

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💊 PHARMACOLOGY

• NSAIDs → short-term use
• Acetaminophen → alternative

📌 DOI: 10.3390/jcm11216494
🔗 https://pmc.ncbi.nlm.nih.gov/articles/PMC9592509/

⚠️ Avoid prolonged NSAIDs (healing interference)

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🔄 FUNCTIONAL PHASE (48–72h)

• Early mobilization
• Functional brace / taping
• Progressive weight-bearing

📌 DOI: 10.3390/jcm11216494

👉 Superior outcomes vs immobilization

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🏋️ REHABILITATION

1. ROM

   • Alphabet exercises

2. Strength

   • Resistance bands

3. Proprioception

   • Balance training

4. Return to sport

🔗 https://emedicine.medscape.com/article/1907229-treatment

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⚠️ SEVERE (GRADE III)

• Immobilization: 7–10 days
• Orthopedic referral
• Surgery → rare

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📈 RECOVERY

Severity	Time
Mild	1–2 weeks
Moderate	3–6 weeks
Severe	≥8–12 weeks

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🚨 COMPLICATIONS

• Chronic instability
• Recurrent sprains
• Osteochondral lesions

📌 DOI: 10.1177/0363546516682495

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🧠 OPERATIONAL INSIGHT (KEY MESSAGE)

👉 Ankle sprain = mobility failure event

• Avoid over-immobilization
• Prioritize early function
• Rehab determines outcome

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🧩 CLINICAL SHIFT (2026)

❌ Immobilization-centered
➡️
✅ Function-centered

📌 DOI: 10.3390/jcm13020511
🔗 https://pmc.ncbi.nlm.nih.gov/articles/PMC11229291/

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🎯 TAKE-HOME MESSAGE

“RICE + REHAB = RECOVERY”

👉 First 72h define trajectory
👉 Rehabilitation defines outcome

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🧾 AUTHOR

Dr Ramon Reyes, MD ⚕️
Emergency | Tactical | Operational Medicine

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