Ankle


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Special Program Proven to Prevent Repeat Ankle Sprains

Health care reform has given researchers reason to study the cost-effectiveness of medical treatment and find ways to improve results with less expense. Athletic injuries make up a huge proportion of health care costs in young adults.

In particular, lateral ankle sprains (the outside of the foot) are the focus of this study. There are literally thousands of ankle sprains occurring everyday in the United States and over half a million per year in The Netherlands. With that in mind, this report from The Netherlands on how to save money by preventing recurring (repeated) ankle sprains is very timely.

More than 500 adults (men and women athletes) were enrolled. They came from emergency department referrals, general practice and physical therapy offices, and some nonmedical channels (e.g., newspaper ads, the Internet, sports events). Everyone had a lateral ankle sprain.

Half of the men and women were placed in an intervention group. The other half made up the control group. Everyone in both groups was treated with what is called usual care. The basic R.I.C.E. formula is used: rest, ice, compression, and elevation during the acute phase (first 48 hours). Early movement and weight-bearing are encouraged with usual care.

The intervention group was also instructed in a special program of proprioceptive training. Proprioceptive exercises are designed to restore the joint's sense of position change. Finely tuned proprioception is important so that the foot and ankle respond to tiny changes in position.

Good proprioception allows the ankle to readjust its position when you walk on uneven ground, step on a rock, or get pushed off balance suddenly. Without an accurate sense of position, the ankle may twist or rotate too far in one direction before pulling back. And by that time, it's too late and another sprain has occurred. The program consisted of 30-minute sessions performed at home (unsupervised) three times per week for eight weeks.

Outcomes were measured in two ways: first, the number of recurrent (repeated) ankle sprains and second, costs. Costs were broken down into two segments: productivity loss (absence from work) and medical costs (referred to as health care utilization).

Medical costs included any visits to a health care professional for the ankle sprain and any tests (X-rays or other imaging) or procedures performed. Health care utilization also included any devises used (e.g., crutches, tape, ankle brace, balance board) and any medications taken during recovery for the ankle sprain. The cost of the intervention program was also factored in.

When the information collected was broken down and carefully analyzed, they found higher costs per athlete in the control group. That's because there were twice as many repeat ankle sprains in that group compared with the intervention group.

So, even though the intervention group cost more, the results were better. With fewer ankle sprains, there were lower medical costs and less work money lost (productivity) because of fewer work (or sports) absences. The authors used charts, graphs, and tables to show the results. They also provided a breakdown of the cost differences between the two groups
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They concluded that an unsupervised at-home program of proprioceptive exercises is not only effective, but also cost-effective. Preventing recurrent ankle sprains saves money. The benefits of a proprioceptive training program far exceed the cost. The savings to society could be in the millions with a simple proprioceptive training program.

Maarten D. W. Hupperets, PhD. Potential Savings of a Program to Prevent Ankle Sprain Recurrence. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2194-2200.

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