First-time Ankle Sprain Research Articles

Medicaid Patients Face Limited Access to Care for Ankle Sprains in Unexpanded States.

Our goal was to determine whether state Medicaid expansion and patient insurance statuses affected access to care for ankle sprain patients. Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, and Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, and Texas) states were chosen. Twelve practices from each state (N = 96) were randomly selected from the American Orthopaedic Foot and Ankle Society (AOFAS) directory and called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain using either Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance. An appointment was obtained at 65.6% clinics when calling with BCBS and at 45.8% with Medicaid (P =.006). There was a significant difference in successful scheduling based on insurance status in Medicaid unexpanded states (P = .007). In all states except Iowa, there were more appointments scheduled using BCBS than with Medicaid. The 3 main reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and whether the patient was referred (17.6%). The waiting period for an appointment did not differ by Medicaid expansion or insurance statuses. For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. Level II prospective cohort study.

Does Medicaid Expansion Improve Access to Care for Ankle Sprains?

Category:Ankle; Sports; OtherIntroduction/Purpose:Prior research has found Medicaid patients face greater difficulty scheduling appointments with orthopaedic surgeons compared to those with other insurance. Recently, a number of states have expanded Medicaid coverage as part of the affordable care act, although it is unclear how this expansion impacts the ability of these patients to obtain access to orthopaedic surgeons. We questioned whether Medicaid patients face additional barriers to care for treatment of ankle sprains, an extremely common athletic injury. Our goal was to determine whether individual state Medicaid expansion status, as well as type of insurance accepted, affected access to care for ankle sprains.Methods:Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, Texas) states in similar geographic locations were chosen. Twelve foot and ankle practices from each state (N=96) were randomly selected from the American Orthopaedic Foot & Ankle Society directory. Each clinic was called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.Results:An appointment was obtained at 63 (65.6%) clinics when calling with BCBS and 44 (45.8%) clinics with Medicaid (P=.006). There was a significant difference in appointment scheduling based on insurance status in Medicaid unexpanded states (Medicaid=21, 43.8% vs. BCBS=34, 70.8%; P=.007). However, this difference was not significant in Medicaid expanded states (Medicaid=23, 47.9% vs. BCBS=29, 60.4%; P=.219). In addition, in all states except Iowa, a Medicaid expanded state, more appointments were scheduled using BCBS than Medicaid. The three most common reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and lack of referral (17.6%). The waiting period for an appointment was not significantly different depending on insurance status or Medicaid expansion status (Medicaid=3.30 days, BCBS=3.43 days, P=.152).Conclusion:For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. However, when granted an appointment, Medicaid patients waited a comparable amount of time to the appointment as those using private insurance.

Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System.

BackgroundWhereas ankle-foot injuries are ubiquitous and affect ~16% of military service-members, granularity of information pertaining to ankle sprain subgroups and associated variables is lacking. The purpose of this study was to characterize and contextualize the burden of ankle sprain injuries in the U.S. Military Health System.MethodsThis was a retrospective cohort study of beneficiaries seeking care for ankle sprains, utilizing data from the Military Health System Data Repository from 2009 to 2013. Diagnosis and procedural codes were used to identify and categorize ankle sprains as isolated lateral, isolated medial, concomitant medial/lateral, unspecified, or concomitant ankle sprain with a malleolar or fibular fracture. Patient characteristics, frequency of recurrence, operative cases, and injury-related healthcare costs were analyzed.ResultsOf 30,910 patients included, 68.4% were diagnosed with unspecified ankle sprains, 22.8% with concomitant fractures, (6.9%) with isolated lateral sprains, (1.7%) with isolated medial sprains and 0.3% with combined medial/lateral sprains. Pertaining to recurrence, 44.2% had at least one recurrence. Sprains with fractures were ~2-4 times more likely to have surgery within one year following injury (36.2% with fractures; 9.7% with unspecified sprains) and had the highest ankle-related downstream costs.ConclusionFractures were a common comorbidity of ankle sprain (one in five injuries), and operative care occurred in 16.4% of cases. Recurrence in this cohort approximates the 40% previously reported in individuals with first-time ankle sprain who progress to chronic ankle instability. Future epidemiological studies should consider reporting on subcategories of ankle sprain injuries to provide a more granular assessment of the distribution of severity.Level of evidence3b

Ankle Sprains: What Updated Guidelines Mean for You.

Ankle sprains are the most common foot-ankle and sports-related injury for which people seek medical care. People of all ages sprain their ankles. Four in every 10 first-time ankle sprains occur when playing sports. Acute ankle sprains are usually accompanied by swelling, pain, and difficulty walking. Chronic ankle instability is diagnosed when a person continues to have problems with tasks like walking or playing sports 1 year after the original injury. People with chronic ankle instability say their ankle feels unstable or like it "gives way." The JOSPT published updated clinical practice guidelines on diagnosing, managing, and preventing acute ankle sprains and chronic ankle instability in the April 2021 issue. We share what the experts found and what it means for you or for someone for whom you may be caring. J Orthop Sports Phys Ther 2021;51(4):161. doi:10.2519/jospt.2021.0504.

Pain Level, Range of Motion, and Foot Volume Do Not Differ in Recurrent and First-Time Ankle Sprains.

Objective. This study aims to describe the clinical features in terms of pain perception, ankle range of motion, and foot volume in participants with recurrent ankle sprains compared with first-time sprains. Methods. Individuals with grade I and II ankle sprains were referred to physiotherapy care for further rehabilitation by their general practitioner. Primary outcome measures were range of movement, pain, and foot volume. Recurrences were described according to engagement in sport. Results. A total of 115 participants were recruited (age = 22.2 ± 6.9 years; female, 84). Neither pain level (P = .822), nor range of motion (dorsiflexion P = .452; plantar flexion P = .436; inversion P = .383; eversion P = .657), nor foot volume (P = .654) were significantly different between the groups: individuals with first-time sprain or with recurrences. Conclusion. Pain and high existence of other lower-limb injuries were reported disregarding the presence of a recurrence. Clinically, it is difficult to differentiate recurrent sprain from a first-time ankle sprain by means of foot volume, range of movement, or pain intensity.

Pediatric and adolescent ankle instability: diagnosis and treatment options.

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and treatment for lateral ankle instability in pediatric patients. Chronic ankle instability is a common sequela of lateral ankle sprain in young athletes. Incidence is increasing, possibly due in part to inadequate treatment of first-time ankle sprains, as well as increased youth participation in organized and competitive sports. The anterior talofibular ligament (ATFL) is injured in every case, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases. A clinical history, focused physical exam, and appropriate radiographic studies aid in diagnosis, and predisposing factors must be identified. Early treatment of ankle sprains involves bracing or immobilization, followed by a course of physical therapy. Surgery involves anatomic repair of the torn ligaments, and may be required in cases of severe functional and mechanical instability with recurrent sprains refractory to nonsurgical management. Intraarticular disorders should be identified and may be addressed with ankle arthroscopy. Prompt treatment of lateral ankle instability in young athletes is important to prevent chronic ankle instability. Many patients are successfully treated without surgery, and those requiring operative intervention improve function postoperatively.

Avulsion fracture of the distal fibula is associated with recurrent sprain after ankle sprain in children.

The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children. Patients who sustained a first-time ankle sprain were prospectively surveyed. Patients underwent radiography of the ankle in the mortise, lateral, anterior talofibular ligament (ATFL), and calcaneofibular ligament views at the first clinic visit to assess avulsion fractures of the distal fibula. Patients with avulsion fractures underwent radiography after 8weeks to assess bone union. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. Recurrent sprain and quality of life were evaluated by using the Self-Administered Foot Evaluation Questionnaire and reviewing the medical records of patients. The association between avulsion fracture and recurrent sprain was assessed using univariate and multivariate analyses. A total of 143 patients with a median age of 9 (range 6-12) years were analyzed. Avulsion fractures were present in 89 (62%) patients. The sensitivity of the ATFL view for the diagnosis of avulsion fractures was 0.94, whereas that for the anteroposterior and lateral views was significantly lower at 0.46 (P < 0.001). Only 17% of fractures united at 8weeks. Of 114 (follow-up rate, 80%) patients who were followed up for a median period of 24 months, recurrent sprain occurred in 41 (36%) patients. The incidence rate was significantly higher in patients with avulsion fractures than in patients without the fractures (44 vs. 23%, P = 0.027). In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P = 0.027). More than one-third of patients experienced recurrent sprain. The presence of avulsion fracture was associated with an increased risk of recurrent sprain. Patients with avulsion fracture and their parents should be informed about the risk of recurrent sprain and subsequent ankle instability, and careful follow-up is needed for these patients. III.

Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies

ImportanceAnkle sprains are the most common sports-related injuries for which effective preventive measures exist. This review summarises the preventive effectiveness of this neuromuscular training (NMT), culminating in an overview of effective exercise components.ObjectiveTo assess the preventive effect of NMT for first-time and recurrent ankle sprains in sports.Evidence reviewAn electronic literature search of PubMed, SPORTDiscus and EMBASE was conducted (until 24 March 2016) to identify published randomised controlled trials (RCTs), controlled trials (CTs) and time trend analyses related to NMT as a preventive measure for ankle sprains. Methodological quality of relevant studies was assessed using a predefined set of 19 criteria. Meta-analyses were performed on comparable populations and intervention content.FindingsA total of 30 studies met the inclusion criteria and were analysed (24 RCTs, 3 CTs and 3 time interventions). Studies showed a great diversity in preventive effects and methodological quality (quality score ranged between 47% and 100%). The diversity in preventive effect was independent of study quality and design. A total of 14 studies focussed solely on the effectiveness of balance training, and 16 studies evaluated the effect of balance training combined with adjunct interventions. Pooled data showed a significant reduction in the occurrence of ankle sprains (relative risk (RR) 0.60; 95% CI 0.51 to 0.71). Single-component interventions specifically targeted at ankle sprains achieved preventive effects (RR=0.58; 95% CI 0.48 to 0.72) as opposed to multicomponent interventions (RR 0.67; 95% CI 0.37 to 1.24). With respect to interventions targeted at general injuries, significant effects were found using both single-component (RR=0.71; 95% CI 0.52 to 0.97) and multicomponent interventions (RR=0.55; 95% CI 0.41 to 0.74). Pooled data showed a significant reduction of NMT on ankle sprains in studies including participants regardless of their injury history (RR=0.59; 95% CI 0.49 to 0.71), and in athletes with a previous ankle sprain (RR=0.69; 95% CI 0.49 to 0.98).Conclusions and relevanceNMT is effective at reducing ankle sprains in a sporting population, and in athletes with a previous ankle sprain. The evidence for an effect on first-time ankle sprains remains inconclusive. A key element of NMT to prevent ankle sprains is balance training, irrespective of the use of balance boards or other balance devices. Since both single-component and multicomponent NMT interventions are effective at reducing ankle sprains, the type most fitting to the context should be chosen for implementation efforts.Level of evidenceLevel 1.

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. Economic evaluation based on cost-utility analysis. Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle sprains.

Which Support is Best for First-Time Ankle Sprains?

Which Support is Best for First-Time Ankle Sprains?

A prospective, randomized clinical investigation of the treatment of first-time ankle sprains: Beynnon BD, Renstrom PA, Haugh L, et al. Am J Sports Med 2006;34:1401–12

A prospective, randomized clinical investigation of the treatment of first-time ankle sprains: Beynnon BD, Renstrom PA, Haugh L, et al. Am J Sports Med 2006;34:1401–12

A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

A Prospective, Randomized Clinical Investigation of the Treatment of First-Time Ankle Sprains

Background Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. Hypothesis There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. Results Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. Conclusion Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.

First-Time Inversion Ankle Ligament Trauma

Background Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. Hypothesis The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). Study Design Cohort study; Level of evidence, 2. Methods Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. Results A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P=. 21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P=. 045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. Conclusion In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.