“The ankle sprain is often trivialized by a large majority of the population which ignores the risks of recurrence and chronic instability, in the absence of appropriate care”. This is the recall published yesterday by the High Authority for Health which is alarmed by bad care today.
Almost half of the people with a sprain have consequences
The announcement can amaze. Indeed, the ankle sprain is a rather common injury. A poorly leveled sidewalk or after a false movement and the (bad) round is played. But obviously we don’t necessarily know how to react well.
A problem perceived by Dr Gérald Kierzek, emergency doctor and medical director of True Medical on a daily basis. “”In reality, or people consult for nothing in the emergency room and wait several hours to be answered: ‘Go home, put yourself at rest, with analgesic, icing and attellfish (Rice protocol) and you will reconsult your attending physician in a few days to judge rehabilitation’. So without radio. Either they do not consult when they should “.
However, according to the HAS, up to 40 % of people who have undergone a first sprained episode of the lateral collateral ligament of ankle thus develop instability. “A significant number of people live, in the months and years following the spraining episode, persistent symptoms, in particular residual symptoms of instability, and activity limitations such as sports and/or activities of daily life”specifies the authority.
A consultation within 24 hours is essential
The health authority does not spare its words: as soon as a sprain causes the slightest symptom – pain, swelling or difficulty in moving – a medical consultation or physiotherapy should be considered within 24 hours. A measure now deemed essential to avoid complications.
“This consultation aims to assess the need to predict, or not, a rehabilitation – particularly in order to prevent the risks of recurrence and chronic ankle instability – and to provide advice for lack of rehabilitation, if applicable”explains the High Authority for Health.
Dr. Kierzek adds the need for imaging in the event of a risk of bone tearing according to the criteria of Ottawa as soon as certain criteria appear.
- The inability to endure the weight at 4 steps (2 times 2 steps on each member), immediately after the injury and during the consultation, because of the pain felt in the foot/ankle region;
- Pain felt during the palpation of bone malleoli and at the level of the bones of the foot);
- An age of less than 18 years or more than 55 years
“Only one of these criteria must lead to an x -ray. On the other hand, if none of these criteria is at stake, direction a medical consultation only”.
Progress remains to be made to simplify the management
For our emergency artist, the recommendation therefore makes sense. But in a practical concern, he regrets that pharmacists have not been involved so far, “Because many patients present themselves at the pharmacy and the Ottawa criteria could be applied to it”.
If rehabilitation is deemed necessary, it must first last between five and seven days, then give rise to a reassessment of the situation: either the patient can resume a normal activity, or he continues his rehabilitation. However, the HAS refrains from fixing a standard number of sessions, which must be personalized. “”The current literature does not make it possible to define a minimum or maximum number of sessions for the treatment of sprains of the lateral collateral ligament “, she warns.
But then again, for more impact, Dr. Kierzek questions: “What about these recommendations for direct access to the physiotherapist? “. In a press release, the Order of Masseurs-physiotherapists did not fail to answer: “It is now necessary to go to the end of this logic: to generalize direct access to all physiotherapists, regardless of their place and mode of exercise. It is a good sense measure, which meets patient expectations, clarifies the care path and facilitates the organization of work in the field“”. The health of our ankles may depend on this “flexibility”.