Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System.
Daniel I Rhon, Tina A Greenlee, Chad E Cook and 3 others
PMID 34631252WHAT IT FOUND
Fractures accompany nearly one in five ankle sprains, and recurrence is common.
Over half of patients received no rehabilitation, and those who did waited a mean of 72.6 days. Clinicians should screen for fractures and consider earlier access to care rather than assuming sprains are self-limiting.
Key findings
01Fractures were present in 22.8% of the ankle injury cases, making them a common comorbidity that warrants routine clinical examination.
02Almost half of the cohort (44.1%) experienced at least one recurrence within one year following the initial injury.
03More than half of individuals did not receive rehabilitation care, and among those who did, the mean delay to first intervention was 72.6 days.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relies on administrative billing codes, meaning the true burden of injury is likely higher because many individuals may self-manage without seeking care. Most ankle sprains were coded as 'unspecified' (68.4%), which limits the ability to draw specific conclusions about different types of sprains (e.g., lateral vs. medial). The cohort is specific to the US Military Health System, a closed single-payer environment, so findings may not generalize to civilian populations with different care-seeking behaviors and insurance structures. The study could not determine laterality of injury or confirm chronic ankle instability diagnoses directly, using recurrence of care-seeking as a proxy for persistent symptoms.
Declared interests
No authors have any competing or conflicts of interest to declare.
The easy way to misread this
Do not interpret the 44.1% recurrence rate as a measure of chronic ankle instability prevalence. The study used care-seeking episodes as a proxy for recurrence, and the authors explicitly state the methodology does not allow for determination of a chronic ankle instability diagnosis.