Authors (including presenting author) :
Yip KY (1), Tse LF (2)
Affiliation :
(1)Department of Prosthetics and Orthotics, Tuen Mun Hospital, (2) Orthopaedics & Traumatology, Union Hospital
Introduction :
Lateral ankle sprains, the most frequent musculoskeletal injury, are associated with pain, muscle weakness and a high risk of reinjury. The use of ankle foot orthosis (AFO) is a conservative way usually recommended to patients with a previous or recurrent ankle sprain to give restrictions on the ankle’s range of motion and provide external support to the ankle to reduce ankle instability and prevent an ankle sprain. Current treatment guidelines for treating lateral ankle sprains suggested PRICE (Protection, Rest, Ice, Compression, Elevation) treatment protocol or the ICE (Immobilization, Compression and Elevation) approach followed by taping to handling an acute ankle sprain in the first few days of injury. Prescription of ankle braces at this stage is uncommon unless the patient was planning to participate in sports with high re-injury risk. Even though the functional ability of ankle foot orthoses is approved, whether AFO performed better than other functional support for an acute ankle sprain is not investigated.
Objectives :
The objective of this systematic review is to evaluate the effectiveness of ankle-foot orthosis on functional support and pain control.
Methodology :
A systematic literature search was conducted using the database MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and SPORTDiscus by means of a combination of keywords. Randomized controlled trials (RCTs) and cohort studies in English and Chinese published between 1990 and 2022 that compared the use of ankle foot orthoses with other non-surgical treatments for acute ankle sprain of adults were included in this review. Articles published since 1990 were covered in the research because it was the time when functional supports started to be used in the part of conservative treatment of ankle sprains. Keywords identified in the research question are “ankle sprain”, “ankle foot orthosis” and “acute”. Therefore, these words and the corresponding synonyms composed the keyword string used in this search. The search keyword string was “(ankle sprain OR ankle injur* OR ankle trauma OR ankle inversion injur* OR ankle inversion sprain) AND (ankle foot orthosis OR ankle brace OR AFO OR bracing OR ankle splint) AND acute” that showed up in all fields. Apart from searching this keyword string in the databases, the reference lists of relevant articles were screened to look for other potentially valid papers. After being identified, the articles were saved in a software named EndNote for eliminating duplication. Individuals greater than 16 years old with an acute lateral ankle sprain and treated by functional interventions with at least one type of ankle foot orthosis were included in the studies. The control treatment can either be another type of AFO or non-surgical intervention other than an ankle brace. Therefore, treatments with surgeries or therapies which requires patients to perform functional exercises related to the ankle are also excluded. The results related to pain or functional outcomes were considered in this study.
Result & Outcome :
An ankle sprain is the most common musculoskeletal injury and conservative treatment is common management. However, there are limited guidelines for the type of functional orthosis to be used in different conditions. From previous systematic reviews and many RCTs, most acute grade I to III ankle sprains could be handled without surgical interventions but only non-operative measures. This systematic review found evidence for better functional outcomes with an ankle brace and no negative side effects were not related to the prescription of AFOs. To conclude, the use of ankle foot orthosis gives a positive effect on the recovery of functional outcomes of a sprained ankle. However, all 5 studies included in this review reported there is no evidence that the use of AFO is beneficial in reducing pain over other conservative treatments. This systematic review suggests use AFO after a short period of immobilization for a few weeks for grade II and grade III cases. Although ankle brace gave superior results in short-term functional outcomes, the advantage of using AFO over other functional supports reduces with time. In the long term, the use of different functional supports gives no difference in pain control and functional outcomes. With better functional outcomes in short term and similar pain control, the use of ankle foot orthosis seems to be the favorable intervention for treating acute ankle sprain over other functional strategies such as taping, elastic bandage or Tubigrip in the acute phase. Among the currently available evidence, it is unclear which type of ankle foot orthosis is the most effective one clinically.
