This study aimed to determine the effectiveness of treatments for patients with chronic complaints following an ankle sprain. While most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. At this time, it is still not clear which treatment options are best for these patients. A search was made in major databases as Pubmed, Embase, Cinahl and PEDro selecting RCTs and CCTs covering the period 1966 to October 2012. Because of clinical heterogeneity, data were analysed using a best-evidence synthesis. In all, 20 randomized controlled trials and 1 controlled clinical trial were included. These compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training and functional treatment). Limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment, with respect to pain and function. Two studies found a decrease of recurrences after a proprioceptive training program. In four studies different surgical methods exhibited good results, but without comparing to a non-surgical control group. Limited evidence was found for the effectiveness of an early mobilizing program after surgery.
In chronic ankle complaints following an ankle sprain, a training program gives superior results for pain and function, and a decrease of recurrent ankle sprains, than a ‘wait and see’ policy. There is insufficient evidence to determine the most effective surgical treatment, but limited evidence indicates that postoperative, early mobilization is more effective than plaster cast.