# Acute ankle sprain (lateral ligament) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Bachmann LM et al. BMJ 2003;326:417 (PMC149439) · Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) · Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) · Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) · Bergman R, Li D, Shuman VL. Acute Ankle Sprain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK459212. PMID: 29083595. - Verified date: 2026-08 ## Verified against - Bachmann LM et al. BMJ 2003;326:417 (PMC149439) - Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) - Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) - Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) - Bergman R, Li D, Shuman VL. Acute Ankle Sprain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK459212. PMID: 29083595. ## Treatment metadata - Decide the X-ray with the Ottawa ankle rules - Diclofenac diethylamine — topical.gel - Ibuprofen — 400 mg — oral.solid - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text ACUTE ANKLE SPRAIN (LATERAL LIGAMENT) Sources: Bachmann LM et al. BMJ 2003;326:417 (PMC149439) · Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) · Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) · Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) · Bergman R, Li D, Shuman VL. Acute Ankle Sprain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK459212. PMID: 29083595. Review status: REVIEWED against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination RED FLAGS (4) - Cannot bear weight for four steps - X-ray - Bone tenderness at either malleolus, the navicular or the fifth metatarsal base - X-ray - A limping child - the growth plate fails before the ligament does, so this is not a sprain until imaged - Cannot lift the heel off the ground or a palpable gap in the tendon - suspect Achilles rupture, refer SYMPTOMS - what the patient reports (5) - Inversion injury, then pain on the outer side of the ankle - Ask whether they could put weight on it at the time, not only now - the rule asks about both - It happens when inversion or eversion force runs past what the ligaments can take, and they stretch, tear partly, or rupture outright - The acute inflammatory response is what produces the pain, the swelling and the instability of the joint - What raises the risk from within: poor proprioception, a previous ankle sprain, lax ligaments and malalignment of the lower limb SIGNS - what you find (6) - Palpate all four malleolar points: posterior edge and tip, medial and lateral - Palpate the navicular and the base of the fifth metatarsal - Watch them take four steps, two on each foot - limping still counts as bearing weight [limp] - Most sprains take the lateral ligament complex, above all the anterior talofibular ligament, which is the weakest and the one most often injured - A worse injury also reaches the calcaneofibular ligament, and rarely the one behind it, the posterior talofibular - The medial deltoid sprain and the high ankle syndesmotic sprain are less common but carry greater morbidity TESTS (1) - No blood test. The only question is whether to X-ray, and the rules answer it Score Ottawa ankle rules - Does this ankle need an X-ray? Source Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003;326:417 Status traced to the source above 1. DECIDE THE X-RAY WITH THE OTTAWA ANKLE RULES [1st line] Adult Open the Ottawa ankle rules before requesting a film. If no rule is positive, an X-ray is not needed. Peds No paediatric dose is stated in the sources held for this drug. Source Bachmann LM et al. BMJ 2003;326:417 (PMC149439) Why A rule that says when NOT to image is the useful half. Imaging every twisted joint is how a clinic fills its X-ray list with normal films. Caution A negative rule is a reason not to X-ray, not proof there is no fracture - it pooled 97.6% sensitivity, not 100%. Bearing weight must be checked at the time of injury AND now; one of the two is not the rule. Not validated as a reason to withhold imaging in a limping child - the growth plate fails before the ligament. 2. DICLOFENAC DIETHYLAMINE [1st line] Adult 2-4 g (a circle 2.0-2.5 cm across) rubbed in 3-4 times daily - review after 14 days Peds Contraindicated under 14 years (SmPC 4.2). It is not a smaller dose for a younger child - the product is not licensed for them at all. Source Voltarol 1.16% Emulgel SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 366) Why Named first because its label names this injury: SmPC 4.1 covers trauma of tendons, ligaments, muscles and joints due to sprains, strains and bruises. A topical NSAID reaches the painful tissue without the gastric and renal exposure of a swallowed one. Caution Do not apply to broken skin, open wounds, or mucous membranes. Avoid in the last trimester of pregnancy. Wash hands after applying unless the hands are the site treated. Egypt VOLTAREN 1% EMULGEL 25 GM NOVARTIS > GL... 39.00 EGP DICLOPRO 1% GEL 50 GM DBK PHARMA > ... 52.00 EGP VOLTAREN 1% EMULGEL 50 GM NOVARTIS > GL... 68.00 EGP VOLTAREN 1% EMULGEL 100 GM NOVARTIS > GL... 101.00 EGP 3. IBUPROFEN [2nd line] Adult 200-400 mg orally 3-4 times daily with food, at least 6 hours apart - maximum 1200 mg in 24 hours; shortest duration that controls the pain Peds A limping child after an ankle or knee injury is not managed as a sprain. The growth plate is weaker than the ligament, so the same force that sprains an adult fractures a child - assess for a physeal injury rather than prescribing and waiting. Source Ibuprofen 400 mg film-coated tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 7020) Why SmPC 4.1 lists painful swelling and inflammation after soft tissue injuries. Second line to the gel only because a swallowed NSAID exposes the whole patient to reach one joint. Caution Avoid in active peptic ulcer, and in severe heart, liver or kidney disease. Co-prescribe a PPI if elderly or at GI risk. Avoid in the third trimester of pregnancy. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 4. PARACETAMOL [add-on - not a substitute] Adult 1 g (two 500 mg tablets) orally every 4-6 hours - maximum 4 g in 24 hours; not more than 3 days without review Peds Paediatric dosing is by weight and is not given here; see the child's own condition entry. Source Paracetamol 500 mg Tablets SmPC sections 4.1 Therapeutic indications and 4.2 Posology (eMC product 5164) Why Add-on for a patient who should not have an NSAID, or alongside one. It does not replace the NSAID - it has no anti-inflammatory action on the injured ligament. Caution Count every other product the patient is taking that contains paracetamol. Reduce the dose in low body weight, chronic alcohol use or hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)