With a sprained ankle, it is often the amount of bleeding and swelling rather than the severity of the torn tissue that determines the length of the disability. First aid for an ankle sprain can make a significant difference in the duration of disability suffered.
The inversion (lateral) ankle sprain is one of the most common soft-tissue injuries. Most of these sprains do not require casting or surgery. However, first aid is an important part of the care. A person giving first aid can remember the proper procedures through using the mnemonic R-I-C-E.R: REST
Bleeding, swelling and pain need to be minimized. This is best done by rest, which means avoiding any weight bearing. Crutches are usually the most effective way of resting the ankle. Complete rest is usually required for no more than 72 hours.
Cryotherapy, or cooling the injured part, is an acceptable part of first aid. Cryotherapy reduces bleeding, swelling, pain and muscle spasm when used soon after an injury. The only exceptions involve Raynaud's disease and cold allergy.
Cold is more effective than heat in initial care. Ice should be applied as soon after the injury as possible, and then about every 4 hours for the next 1 to 3 days. Cryotherapy continues to be useful before and after exercise during rehabilitation.
Crushed ice, ice cubes or ice chips contained in a plastic bag or wet towel conform well to the contour of the ankle and are the recommended form of cryotherapy. If a towel is not used, a layer of wet cloth (such as a compression bandage) should be placed under the ice to prevent cold damage to the superficial tissues. Cryotherapy using a bucket with ice slush or ice water is another method of cooling the ankle, but this may be uncomfortable for the victim. Alternative cooling agents are not superior to ice and are less convenient and more expensive. Chemical ice packs may not become cold enough. Frozen gels may be too cold because they reach the temperature of the freezer in which they are stored. Ethyl chloride spray may overcool the skin while undercooling the deeper structures of the ankle.
Each application of ice should last for about 20 minutes. Shorter use may not allow adequate cooling of the deeper tissues. Longer use may lead to overcooling of the superficial tissues. There is also some evidence that use of 30 minutes or more may increase swelling by causing vasodilation (enlarging the skin's blood vessels).
Compression of the injured ankle's areas is a very important part of first aid. If possible, it should not be interrupted during ice therapy. An elastic bandage, preferably one that is three inches wide, should be used.
Ankle compression for an inversion ankle sprain must take into account the bleeding and swelling in the hollow areas beneath and around the outside ankle knob (malleolus). An elastic bandage applied directly over the ankle does not compress these areas effectively because the malleolus pulls the bandage away from the depressions. Fill the hollow areas before applying the elastic bandage. Material such as a disposable diaper folded three times so it is five layers thick and cut into horseshoe shape to surround the malleolus can be used. The diaper's absorbent side should be placed against the skin. The victim's sock can be formed into a horseshoe shape or 1/4-inch thick felt can also be used.
After the horseshoe shaped material is placed around the ankle knob (malleolus), apply an elastic bandage to place compression. This reduces bleeding and swelling in the soft tissue.
The victim, while sitting, should raise the ankle above the level of the waist. Sleeping with one's leg elevated on a pillow is not very practical.
Because prompt starting of R-I-C-E is important in minimizing the number of days disabled and having an ankle susceptible for future injury, all people should know how to perform the above first aid.
- Alton Thygerson is a professor of health sciences at Brigham Young University.