Department of Family Medicine, University of Illinois College of Medicine, Chicago, IL 60607, USA.
Am Fam Physician. 2012 Jun 15;85(12):1170-6.
Ankle sprains are a common problem seen by primary care physicians, especially among teenagers and young adults. Most ankle sprains are inversion injuries to the lateral ankle ligaments, although high sprains representing damage to the tibiofibular syndesmosis are becoming increasingly recognized. Physicians should apply the Ottawa ankle rules to determine whether radiography is needed. According to the Ottawa criteria, radiography is indicated if there is pain in the malleolar or midfoot zone, and either bone tenderness over an area of potential fracture (i.e., lateral malleolus, medial malleolus, base of fifth metatarsal, or navicular bone) or an inability to bear weight for four steps immediately after the injury and in the emergency department or physician's office. Patients with ankle sprain should use cryotherapy for the first three to seven days to reduce pain and improve recovery time. Patients should wear a lace-up ankle support or an air stirrup brace combined with an elastic compression wrap to reduce swelling and pain, speed recovery, and protect the injured ligaments as they become more mobile. Early mobilization speeds healing and reduces pain more effectively than prolonged rest. Pain control options for patients with ankle sprain include nonsteroidal anti-inflammatory drugs, acetaminophen, and mild opioids. Because a previous ankle sprain is the greatest risk factor for an acute ankle sprain, recovering patients should be counseled on prevention strategies. Ankle braces and supports, ankle taping, a focused neuromuscular training program, and regular sport-specific warm-up exercises can protect against ankle injuries, and should be considered for patients returning to sports or other high-risk activities.
踝关节扭伤是初级保健医生常见的问题，尤其是在青少年和年轻人中。大多数踝关节扭伤是外侧踝关节韧带的内翻损伤，尽管越来越多的高踝关节扭伤代表了胫腓联合的损伤。医生应应用渥太华踝关节规则来确定是否需要进行放射照相检查。根据渥太华标准，如果存在外踝或中足部区域的疼痛，并且存在潜在骨折区域（即外踝、内踝、第五跖骨基底或舟骨）的骨压痛，或者在受伤后立即和在急诊室或医生办公室不能承受四步的重量，则需要进行放射照相检查。踝关节扭伤患者应在最初的三到七天内使用冷疗来减轻疼痛并改善恢复时间。患者应穿系带式踝关节支撑或空气靴式支撑，结合弹性压缩绷带，以减轻肿胀和疼痛，加快恢复速度，并在受伤的韧带变得更加活动时保护它们。早期活动比长时间休息更有效地加速愈合并减轻疼痛。踝关节扭伤患者的疼痛控制选择包括非甾体抗炎药、对乙酰氨基酚和轻度阿片类药物。因为以前的踝关节扭伤是急性踝关节扭伤的最大危险因素，所以康复患者应接受预防策略的咨询。踝关节支具和支撑物、踝关节贴扎、集中的神经肌肉训练计划和定期的特定于运动的热身运动可以预防踝关节损伤，对于返回运动或其他高风险活动的患者应考虑使用。
