Evid Based Nurs 12:113 doi:10.1136/ebn.12.4.113
  • Treatment

Below-knee cast and Aircast brace improved ankle function at 3 months in acute severe ankle sprain


In patients with acute severe ankle sprain, are mechanical supports more effective than double-layer tubular compression bandages (Tubigrip) for enhancing recovery?



randomised controlled trial.




blinded (outcome assessors).

Follow-up period:

1, 3, and 9 months.


8 emergency departments in the UK.


584 patients >16 years of age (mean age 30 y, 58% men) who were unable to bear weight for ⩾3 days after sprain. Exclusion criteria were contraindications to immobilisation, injury date >7 days ago, or recent fracture (except flake fracture <3 mm).


below-knee cast (n = 142), Aircast brace (n = 149), Bledsoe boot (n = 149), or Tubigrip (n = 144). Before randomisation, ankles were elevated and immobilised with tubular compression bandages for 2–3 days to stabilise oedema. Trained plaster technicians, physiotherapists, and nurses applied the supports.


ankle function (Foot and Ankle Score [FAOS], range 0 to 100 [no symptoms]).

Patient follow-up:

82% at 3 months; <80% at 9 months (intention-to-treat analysis).

Main results

Compared with Tubigrip, the below-knee cast improved ankle function and pain; the Aircast brace improved ankle function (table). The Bledsoe boot did not differ from Tubigrip for any outcome (table). The FAOS activities of daily living and FAOS sports scores are not reported here because they had <80% follow-up.

Below-knee cast or Aircast brace or Bledsoe boot v Tubigrip for acute severe ankle sprain*


In patients with acute severe ankle sprain, the below-knee cast improved ankle function and pain at 3 months more than tubular compression bandaging (Tubigrip). The Aircast brace improved ankle function more than Tubigrip. The Bledsoe boot did not differ from Tubigrip for any outcome.

Abstracted from

Lamb SS, Marsh JL, Hutton JL, et al. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet 2009;373:575–81.

Clinical impact ratings: Emergency 6/7; Orthopaedics 7/7


  • Source of funding UK Department of Health.


Given the body mechanics, weight, and lifestyle of the adult population, ankle sprain is a common malady. Without proper intervention, recurrence rates within 12 months are high.1 Nurses have vital roles in initial evaluation and discharge education for ankle sprains. Careful history of health risks, lifestyle needs, and compliance obstacles, as well as an understanding of available treatment modalities, can facilitate proper planning for each patient situation.

The use of Tubigrip, ice, and elevation to treat ankle sprain without complete ligament disruption is an easy, cost-effective, and frequently used regimen. This approach is supported by previous studies of ankle sprain treatments2 showing that wraps and bandages that do not immobilise the ankle allow for earlier return to work and sports without long-term consequences or increased recurrence. Lamb et al’s finding that the best short-term improvement was achieved by restricting movement with a short-leg cast or Aircast splint calls conventional management into question. Although more cumbersome, 10-day casting was superior for improved function and decreased pain, and was the less expensive of the 2 to apply. The Bledsoe boot showed no improvement over Tubigrip and was the most expensive. In the absence of additional injury, all of the options produced similar results at 9 months. What this means is that the evidence is unclear for which treatment of ankle sprains is most advantageous. However, helping patients to choose the right treatment option, given both short-term and longer-term outcomes will determine the most acceptable use of these devices for patients.


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