Management of Lateral Ankle Sprains: Semi-rigid Brace or Soft Ace Bandage
Date First Published:
July 17, 2026
Last Updated:
July 17, 2026
Report by:
Stephanie Eswine MD, Matthew Singh, Senior EM resident, EM Faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey S. Jones MD, Research Director
Three-Part Question:
In [young athletes presenting to the ED with acute lateral ankle sprain] does the [application of a semi-rigid brace (I) compared to a soft bandage/ACE wrap] [result in faster return to sport/play]?
Clinical Scenario:
A 23-year-old patient presents to the Emergency Department with the chief complaint of ankle pain after inversion injury while playing soccer. The patient has tenderness, edema, and ecchymosis over the lateral aspect of the ankle, with positive anterior drawer and talar tilt tests. X-rays are negative for fracture. As the treating physician, you diagnose the patient with a lateral ankle sprain and prepare their discharge recommendations. You wonder if placing them in a semi-rigid brace versus using an ACE wrap will help the young athlete return to play sooner.
Search Strategy:
Medline 1966-06/26 using PubMed, Cochrane Library (2026), and Embase
Search Details:
[("soft bandage"[All Fields] OR "ankle brace"[All Fields]) AND ("lateral ankle sprain"[All Fields] OR ("lateral ligament injury"[All Fields])]
[("lateral ankle sprain"[All Fields] OR ("lateral ligament injury"[All Fields]) AND ("treatment"[All Fields] OR ("Treatment Outcome"[MeSH])]
[("lateral ankle sprain"[All Fields] OR "lateral ligament injury"[All Fields]) AND ("return to play"[All Fields])]
[("lateral ankle sprain"[All Fields] OR ("lateral ligament injury"[All Fields]) AND ("treatment"[All Fields] OR ("Treatment Outcome"[MeSH])]
[("lateral ankle sprain"[All Fields] OR "lateral ligament injury"[All Fields]) AND ("return to play"[All Fields])]
Outcome:
147 total articles were found; two systematic reviews with meta-analysis addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Treatment of acute ankle ligament injuries: a systematic review Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R. August 2013 Berlin, Germany | Adults with grades I-III lateral ankle ligament ruptures | Meta-analysis of 16 RCTs | Pain scores, functional outcome, time to recovery, skin complications | In all studies, patients had better short-term results with a semi-rigid ankle brace than with a bandage | Many studies that were included had methodological flaws; the results were not applicable for the treatment of ankle sprains in children. |
| Functional treatment versus immobilization for the management of acute ankle sprains: a systematic review and meta-analysis Vilchez-Cavazos F, Quiroga-Garza A, Acosta-Olivo CA, Rodríguez-Corpus LA, Espinosa-Uribe AG, Peña-Martínez VM, Simental-Mendía M. October 2025 Monterrey, Mexico | 1133 patients with lateral ankle sprain randomized to functional treatment (elastic wrap, taping) or immobilization (ankle brace) | Meta-analysis of 10 RCTs | Self-reported pain or function and events related to instability, reinjury, or ability to perform daily activities | No significant differences between interventions for pain (p = 0.60), functional improvement (p = 0.83), instability, reinjury, or return to daily activities were identified | The included studies described different treatment approaches, particularly for functional therapy, as well as differences in intervention duration. It was not possible to perform a sub-analysis with interventions such as semi-rigid immobilization or semi-rigid immobilization combined with functional management in the context of acute ankle sprain. Also, the severity of the injury managed ranged from grade I to III. The above may have accounted for the heterogeneity of the results. Not all studies reported the outcomes of interest, which accounts for the relatively small number of participants evaluated for each outcome. |
Author Commentary:
Lateral ankle sprains (LAS) constitute over 75 % of all acute ankle sprains. Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), the RICE protocol (rest, ice, compression, elevation), immobilization, functional support, exercise therapy, and surgery. Among these, two approaches are commonly used: immobilization (including plaster immobilization or an ankle brace) and functional treatment (including casting tape, elastic wrap, or bandaging). Across guidelines, systematic reviews, and athlete-focused work, semi‑rigid (or lace‑up) braces are generally favored over soft bandage/ACE wrap for acute lateral ankle sprain, offering quicker functional recovery, less instability, and better short‑term outcomes. However, more recent studies indicate that functional and immobilization strategies did not significantly differ in improving ankle pain or function, according to patient-reported outcomes. Large-scale comparative effectiveness studies are needed to identify the most effective strategies for different patient subgroups based on injury severity or activity level.
Bottom Line:
Neither functional treatment nor immobilization shows significant advantages over the other in improving ankle pain or function, or in preventing complications in patients with acute lateral ankle sprains.
Level of Evidence:
Level 1: Recent well-done systematic review was considered or a study of high quality is available
References:
- Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R.. Treatment of acute ankle ligament injuries: a systematic review
- Vilchez-Cavazos F, Quiroga-Garza A, Acosta-Olivo CA, Rodríguez-Corpus LA, Espinosa-Uribe AG, Peña-Martínez VM, Simental-Mendía M.. Functional treatment versus immobilization for the management of acute ankle sprains: a systematic review and meta-analysis