Ankle sprains, which are almost the most common type of orthopedic emergency room visit, account for about 25% of all injuries to the musculoskeletal system, the vast majority of which are lateral ligament injuries. As an emergency treatment for ankle sprains, the RICE principle has become a classic: Rest: stop walking, let the injured part rest, reduce further damage; Ice: let the temperature of the injured part decrease, reduce inflammation and muscle spasm, relieve pain and inhibit swelling. Each time 10-20 minutes, more than 3 times a day, pay attention to not directly on the affected area of the ice, can be wrapped in a wet towel ice to avoid frostbite. Ice should only be applied within 48 hours of the injury. Compression: Wrap the injured ankle with an elastic bandage and apply appropriate pressure to reduce swelling. Be careful not to apply excessive pressure, as this will increase swelling and ischemia in the limb farther away from the wrap. Elevation: Elevate the limb above the heart to increase venous and lymphatic return, reduce swelling and promote recovery. RICE is only the principle of emergency treatment (within 24-48 hours) for ankle sprains, so what is the follow-up? In 2012, the British Journal of Sports Medicine recommended replacing the current RICE principle of ankle injury treatment with POLICE: Protect, Optimal loading, Ice, Compression, Elevation, which emphasizes early activity. Ankle injuries are usually categorized into 3 grades depending on the severity of the injury. Grade 1: The ligament is stretched and there is only microscopic damage to the ligament fibers, and the pain is mild. Weight bearing is allowed as long as it is tolerated; no splinting or immobilization is required; isometric contraction exercises are feasible; full range of motion exercises and plyometrics can be performed if tolerated. Grade 2: Partial ligamentous fiber rupture, moderate pain and swelling, limited mobility, possible joint instability. Immobilization with splints or braces, physical therapy, and plyometric and joint mobility exercises are required. Grade 3: Complete rupture of the ligament with significant swelling and pain and joint instability. Braking and rehabilitation are the same as for grade 2, but rehabilitation takes longer and in a few cases surgery is required. Non-surgical treatment It has been suggested that for Grade 1 and 2 ankle sprains, a few days of joint mobility exercises and gradual increase in weight-bearing can lead to faster recovery from ankle sprains. For grade 3 ankle sprains (complete ligament tear), there is evidence to support early braking within 10 days of injury, followed by ankle motion. Of course, many scholars still support 2-3 weeks of braking for grade 3 injuries. The general recommendations are Stage 1, 1 week of RICE, rest to protect the ankle and reduce swelling; Stage 2, weeks 2-3, gradual return of mobility, strength, and flexibility; and Stage 3, over the next few weeks to months, gradual return to sports, beginning with sports that do not require twisting of the ankle, and ultimately returning to physical activity. Medication The available evidence only recommends non-steroidal anti-inflammatory drugs to control pain and inflammatory response. It is worth noting that there is no clear evidence to support all topical medications and manipulative rubbing for revision. Surgical Treatment Only a very small number of patients with grade 3 injuries require surgical treatment after failure of several months of systematic non-surgical treatment. These patients are generally those with severe injuries, significant instability, and demanding sports. Ankle instability usually presents with a positive anterior drawer test as well as a positive talar tilt test, which may also be demonstrated on an ankle orthogonal inversion stress radiograph, in addition to MRI to help in the determination of ligament tears. Surgery can be considered arthroscopic or open reconstruction to repair the ligamentous structures.