Makindo Medical Notes

BT = Bone tenderness. Treat sprains with RICE (Rest, Ice, Compression, Elevation, and Analgesia). If Ottawa rules do not indicate the need for an X-ray, diagnose a sprain and avoid unnecessary imaging. The Ottawa Ankle Rules help reduce unnecessary X-rays by up to 25%.

Additional Notes on Ottawa Ankle Rules

• The Ottawa Ankle Rules are highly sensitive (close to 100%) for detecting fractures in the ankle and midfoot, allowing clinicians to confidently rule out fractures if criteria are not met.
• Do not apply the Ottawa Rules in cases where:
  • The patient has multiple painful injuries, head injury, or intoxication.
  • The patient has reduced sensation or peripheral neuropathy in the lower limbs.
  • There is a high suspicion of a stress fracture (as these often do not present with acute tenderness over bony areas).
• Consider repeat assessment in 5-7 days if significant swelling and pain persist without a clear diagnosis, as occult fractures may become more evident.

Management for Ankle and Foot Sprains (RICE Protocol)

• Rest: Advise limited weight-bearing and use of crutches if necessary, gradually resuming activities as pain subsides.
• Ice: Apply ice packs to the injured area for 15-20 minutes every 1-2 hours during the first 48 hours to reduce pain and swelling.
• Compression: Use an elastic bandage or ankle support to minimize swelling. Ensure it is snug but not too tight to prevent circulation issues.
• Elevation: Keep the injured area raised above heart level to reduce swelling, particularly in the first 24-48 hours.
• Analgesia: Use NSAIDs or acetaminophen to manage pain, with NSAIDs also helping to reduce inflammation.

When to Refer

• If the patient has a suspected high ankle sprain or syndesmotic injury (typically associated with a positive squeeze test).
• When conservative treatment does not alleviate symptoms, or if instability is suspected after initial RICE and analgesia protocol.
• If there are signs of neurovascular compromise, or if the patient has severe functional limitations beyond the usual recovery period (2-6 weeks).