When does R.I.C.E. become R.I.C.E.R. for ankle sprains?

Most high ankle sprains can be using the R.I.C.E. method, but a few of these will need further intervention by a specialist for further investigation. That is where the extra R comes into it - standing for Referral.
Most high ankle sprains can be using the R.I.C.E. method, but a few of these will need further intervention by a specialist for further investigation. That is where the extra R comes into it - standing for Referral.

Ankle injuries can occur in a game of social football or netball, or in everyday activities like walking.

A night out in the town is even a good place to get an ankle sprain, with dancing or unsure footing a good way to place downward pressure on the outside of the ankle.

The most commonly advised treatment for ankle injury is R.I.C.E. treatment which is Rest, Ice, Compression and Elevation, said orthopaedic surgeon Dr Anil Goudar.

"The foot goes down and turns in - that's how the injury is commonly described by patients, this is how the ligament is stretched or torn," he said.

Injuries to ligaments, which join bone to bone and keep the joint stable, are categorised by grades.

Using R.I.C.E. treatment, grade one (stretching of ligament) and grade two (partial tear) is expected to heal within a week or two.

Grade three (complete tear) injuries can take up to four weeks, where immobilisation of the joint in the early part of the injury plays a role in proper healing of the ligaments. Patients are given a moon boot or CAM walker followed by physical therapy to retrain the ankle's stability.

Using the moon boot to immobilise the ankle is essential in healing process as it aids the patient in bearing weight whilst positioning the ligaments in to the correct 'plantigrade' (stands with feet flat on the ground) position.

"Patients should be encouraged to weight bear in the plantigrade position with the support of a moon boot if they are able to - if they need to use crutches to do so, that is fine as well."

Less commonly occurring in the general public are high ankle sprains or ankle syndesmosis injuries, which can be more disabling.

"You may have heard of footballers who have the high ankle sprain and they are out for a season. This is where the ligaments between the lower tibia and fibula above the ankle joint are overloaded and flexed upwards, and can cause significant swelling, bruising and inability to bear weight," said Dr Goudar.

"Most high ankle sprains can be using the R.I.C.E. method, but a few of these will need further intervention by a specialist for further investigation.

"That is where the extra R comes into it - standing for Referral.

"A high velocity injury such as a football tackle or a motorbike accident may be case for referral due to the chance of bone injuries or multiple ligament injuries which may make the joint unstable, and potentially require surgery," he said.

Most commonly surgery is not needed for the first time you have an ankle injury; it tends to be more when you have had an injury followed by ongoing issues with the ligaments' ability to heal.

Sometimes a ligament can heal stretched, or with excessive scarring, or lesions may form in the ankle joint. Such issues can leave the patient with pain and limited movement - and only surgery can alleviate the symptoms.

Even with a common ankle injury, if a patient is finding they cannot bear weight even after two weeks they might need to be referred for further investigation for a more serious tear than originally thought, other associated injuries, and we would check this with an x-ray or an MRI scan.

What to do in the event of an ankle injury

If you injure yourself in a game of weekend footy, R.I.C.E. is adequate for milder injuries in the initial stages - see if you can walk on it.

If it gets better in the next few days, then you don't need to see anyone, said Dr Goudar. But if after few days of immobilisation, the swelling and pain is persisting, and you can't walk on that foot then you should seek medical help.

However, if the injury has occurred at high velocity or with high impact then you are better off getting it checked out straight away.

"Sometimes people don't know if they should put weight on their foot when they injure their ankle, but your body will let you know what it can and can't do. You won't be able to put weight on an ankle that is seriously unstable," he said.

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