Treatment modalities for soft tissue injuries of the ankle: a critical review

We reviewed the English language medical literature on soft tissue injuries of the ankle published between 1966 and 1993. There were 150 articles reviewed of which 84 dealt substantially with ankle soft tissue injuries. The papers were analyzed for quality and it was found that there were significant weaknesses throughout the literature. This related particularly to randomization, blinded assessment, and outcome measures. The results of the treatment of 32,025 patients were reported in 84 studies. We were unable to gather sufficient data from these studies to perform a statistical analysis of the different forms of treatment. Our conclusions were that nonsteroidal antiinflammatory drugs shortened the time period to recovery and were associated with less pain. Active mobilization appeared to be the treatment of choice. Studies also showed that cryotherapy was of benefit and diapulse may be helpful. There was insufficient evidence to conclude that enzyme treatment, topical gels, ultrasound or diathermy, joint aspiration of injection were of benefit. Overall the literature would substantiate active mobilization following ankle sprains with judicious early use of nonsteroidal antiinflammatory drugs and the use of cryotherapy and diapulse in the treatment of ankle injuries. Our study suggests further investigations need to be carried out into the effectiveness and outcomes following alternative forms of therapy for ankle injuries.