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. 2021 Aug 6;13(1):86.
doi: 10.1186/s13102-021-00308-x.

Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability - the later, the worse: a retrospective analysis

Christian Raeder #  1 , Janina Tennler #  2 , Arthur Praetorius  3 , Tobias Ohmann  2 , Christian Schoepp  3
Affiliations

Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability - the later, the worse: a retrospective analysis

Christian Raeder et al. BMC Sports Sci Med Rehabil. .

Abstract

Background: The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20-40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI.

Methods: Between 2015 and 2018 we applied the diagnostic code "sprain of ankle" (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus.

Results: The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1-3 recurrent sprains or 4-5 recurrent sprains (p < .001).

Conclusions: Females over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.

Keywords: Ankle injury; Ankle instability; Epidemiology; FADI; Functional rehabilitation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study design
Fig. 2
Fig. 2
Functional CAIT outcome depending on the frequency of recurrent ankle sprains. *p < .001
Fig. 3
Fig. 3
Functional CAIT outcome depending on the modality of therapy
Fig. 4
Fig. 4
Functional CAIT outcome according to the beginning of therapy. *p < .05
Fig. 5
Fig. 5
Relative distribution of CAI and non-CAI according to the beginning of therapy
See this image and copyright information in PMC

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