eMedicine Specialties > Sports Medicine > Foot and Ankle

Ankle Sprain: Treatment & Medication

Author: Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Apr 28, 2009

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

Rest, ice, compression, and elevation (ie, RICE) are the mainstays of the acute treatment of lateral ankle sprains (see Acute Phase, Other Treatment, below). The goal of acute treatment is to control pain and to maintain or regain range of motion (ROM). Athletes are encouraged to take their ankle out of their brace and to move it through a pain-free ROM. Aggressive pain-free ROM is recommended. Having the athlete spell the letters of the alphabet with his/her foot and ankle several times per day is one simple activity to recommend even in an acute care setting.

Medical Issues/Complications

Pain control is the initial treatment goal for ankle sprains.

  • The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is somewhat controversial.19  Some physicians argue that the anti-inflammatory effects of NSAIDs are helpful in decreasing swelling, which ultimately increases the speed of recovery. Others believe that acutely used NSAIDs may increase swelling by increasing potential bleeding through platelet inhibition.19,20
  • If NSAIDs are not used, acetaminophen or other pain medicines may be required for pain control in some athletes with moderate to severe ankle sprains.21

Surgical Intervention

Surgical intervention may be considered for the treatment of third-degree ankle sprains in high-level athletes and for chronic ankle instability.22 In most cases, normal biomechanical function is not completely restored, but for most patients with chronic ankle instability, satisfactory results can be obtained with various surgical procedures.23,24,25

Other Treatment

Rest, ice, compression, and elevation are the mainstays of treatment; rest is especially critical. Athletes must modify activities that aggravate the ankle sprain; this modification may be as simple as decreasing the amount, frequency, or intensity of sports activities. Often, athletes are more compliant with a decreased level of activity if they are allowed to increase other nonaggravating activities.26
  • An ice pack is the first-line anti-inflammatory treatment; used appropriately, icing has been shown to significantly decrease healing time.13  The ice pack can be made by placing crushed ice in a plastic bag that is wrapped in a towel; a good alternative is using a bag of prepackaged frozen corn kernels wrapped in a towel. Such an ice pack allows it to mold to the foot, thereby increasing the contact area. Ice packs (which should be used after completing exercise, stretching, and strengthening) are usually placed for 15-20 minutes.
  • Placing a compression dressing over the ankle and elevating the ankle as soon as possible after the injury (for 24 h) are important to minimize the swelling. Some useful commercial devices combine compression and ice treatments.
  • Ankle braces
    • Immobilization can both help and hinder healing. Acutely protecting the weakened, painful area is appropriate, but prolonged immobilization leads to muscle atrophy and loss of motion. Limited stress creates a stronger scar formation because the collagen fibers line up parallel to the stress instead of at random. For these reasons, limited immobilization with a stirrup or lace-up ankle brace is usually used (see Image 5) whereas casting is avoided.
    • Occasionally, the use of posterior splinting and crutches with nonweight-bearing ambulation is useful for more severe ankle sprains (ie, when foot motion and weight bearing is extremely painful). Usually, the use of a posterior splint is limited to a few days, and weight bearing as tolerated is encouraged.
    • Ankle braces have been shown to be effective at preventing some types of ankle sprains.5,27,28,29,30,31,32  The use of high-top shoes has been proposed to prevent ankle injuries, but study results have been mixed.31,32,33,34
    • The CAST trial was a randomized controlled trial designed to estimate the clinical effectiveness and cost-effectiveness of 3 methods of ankle support compared with double-layer tubular compression bandage.35 Results of the study showed that the below-knee cast and the Aircast brace offered cost-effective alternatives to tubular bandage for acute severe ankle sprains, with the below-knee cast having the advantage in terms of overall recovery at 3 months. Because no differences in long-term outcome were noted, the investigators suggest that practitioners should consider likely compliance and acceptability to patients when choosing a brace.35
  • Ankle taping
    • Ankle taping can increase ankle stability by at least 2 mechanisms: limitation of motion and proprioception.36  For a single treatment, ankle taping is less expensive than either a brace or an athletic shoe. Initially, the effectiveness of ankle taping is similar to bracing.11,14  However, studies have demonstrated a significant loss of effectiveness after 24 minutes of activity37 ; moreover, ankle taping becomes virtually ineffective after periods as short as 40 minutes.38
    • The effectiveness of ankle taping is highly dependent on the expertise of the individual who performs the taping. Although the primary effect is improved proprioceptive function, taping may also cause variable effects on motor performance. Ankle taping has the potential to either enhance or hinder the function of the peroneal muscles, depending on the location and technique with which the ankle was taped. Thus, having an experienced certified athletic trainer (ATC) or physical therapist do the taping usually produces optimal results. In general, athletes without easy access to an ATC or physical therapist may find an ankle brace easier to use and more effective.

Recovery Phase

Rehabilitation Program

Physical Therapy

The treatment plan during the recovery phase is aimed at the athlete regaining full ROM, strength, and proprioceptive abilities. Strengthening is started with isometric exercises and advanced to the use of elastic bands or surgical tubing (see Image 4). Strengthening is performed in the following 4 cardinal ankle motions: dorsiflexion, plantar flexion, eversion, and inversion. Strengthening of the peroneals, which act as dynamic stabilizers of the ankle, is critical.

  • Proprioception rehabilitation begins with single-leg stance exercises in a single plane and progresses to multiplanar exercises.
    • The athlete stands on the injured side with the foot and arch in a neutral position and holds the foot of the uninjured side off the ground. For safety, this exercise should be completed near a wall.
    • Initially, the athlete looks at the feet and attempts to hold the position. When the athlete can comfortably and easily hold the position for 3 minutes, he/she changes the focus of the eyes to a location in front of the body. When the athlete can comfortably and easily hold the position with the eyes looking forward for 3 minutes, the position is then held with the eyes closed. A modified Romberg test may be useful in evaluating the progression of proprioceptive rehabilitation.
  • Other useful exercises include the use of a balance or tilt board (see Image 3); these can be made by attaching a dowel or half of a croquet ball to the bottom of a piece of plywood. The athlete stands on the board and attempts to control balance while touching the board to the floor in a controlled manner to complete various patterns (eg, 4 points of the compass). Finally, the athlete advances to functional drills, jogging, sprinting, cutting, and then progresses to figure-of-eight and carioca drills.39

Surgical Intervention

Surgical intervention may be considered for the treatment of third-degree ankle sprains in high-level athletes and for chronic ankle instability.22 In most cases, normal biomechanical function is not completely restored, but for most patients with chronic ankle instability, satisfactory results can be obtained with various surgical procedures.23,24,25 Symptoms of chronic instability may include chronic pain and instability despite a course of adequate physical and pharmacologic therapy.

Maintenance Phase

Rehabilitation Program

Physical Therapy

A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.10,29,39,40,41

Other Treatment

Please see Acute Phase, Other Treatment for a discussion of ankle taping and bracing.

Medication

The use of NSAIDs in acute musculoskeletal injuries is somewhat controversial.19  These drugs may or may not be beneficial to the physiologic processes of soft-tissue healing. NSAIDs have been found to be useful in controlling pain and allowing more rapid progression in physical therapy. Disadvantages of these agents include the risk of gastrointestinal (GI) bleeding, gastric pain, and renal damage.20

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are used to control acute inflammation and pain. These agents may also be used for pain control as an adjunct to physical therapy.


Ibuprofen (Ibuprin, Advil, Motrin)

Member of the propionic acid group of NSAIDs. Available in low-dose formulation as an over-the-counter medication. Highly protein bound, metabolized in liver and eliminated primarily in urine. May reversibly inhibit platelet function.

Adult

600-800 mg PO tid/qid

Pediatric

Recommended maximum daily dose: 40 mg/kg PO divided tid/qid

Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of anticoagulation abnormalities or during anticoagulant therapy


Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)

Member of the propionic acid group of NSAIDs. Available in low-dose formulation as an over-the-counter medication. Highly protein bound, metabolized in liver and eliminated primarily in urine. May reversibly inhibit platelet function.

Adult

Dose range: 250-550 mg PO bid/tid; maximum 1100 mg/d when used for pain control and acute musculoskeletal injury; maximum daily dose is 1650 mg for all conditions

Pediatric

10 mg/kg PO divided bid recommended

Coadministration with aspirin increases the risk of inducing serious NSAID-related adverse effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; contraindicated in patients with peptic ulcer disease, recent GI bleeding or perforation, and renal insufficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug.

More on Ankle Sprain

Overview: Ankle Sprain
Differential Diagnoses & Workup: Ankle Sprain
Treatment & Medication: Ankle Sprain
Follow-up: Ankle Sprain
Multimedia: Ankle Sprain
References
[ CLOSE WINDOW ]

References

  1. Pfeffer GB, Clain MR, Frey C, Geppert MJ, Petrik ME. Foot and ankle. In: Snider RK, ed. Essentials of Musculoskeletal Care. American Academy of Orthopaedic Surgeons: Rosemont, Ill; 1997:366-489.

  2. Liu SH, Nguyen TM. Ankle sprains and other soft tissue injuries. Curr Opin Rheumatol. Mar 1999;11(2):132-7. [Medline].

  3. Renstrom PAFH, Kannus P. Injuries to the foot and ankle. In: Delee JC, Drez D, eds. Orthopaedic Sports Medicine. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994:1705-67.

  4. Hammig BJ, Yang H, Bensema B. Epidemiology of basketball injuries among adults presenting to ambulatory care settings in the United States. Clin J Sport Med. Nov 2007;17(6):446-51. [Medline].

  5. Pedowitz DI, Reddy S, Parekh SG, Huffman GR, Sennett BJ. Prophylactic bracing decreases ankle injuries in collegiate female volleyball players. Am J Sports Med. Nov 5 2007;epub ahead of print. [Medline].

  6. Le Gall F, Carling C, Reilly T. Injuries in young elite female soccer players: an 8-season prospective study. Am J Sports Med. Oct 11 2007;epub ahead of print. [Medline].

  7. Tegnander A, Olsen OE, Moholdt TT, Engebretsen L, Bahr R. Injuries in Norwegian female elite soccer: a prospective one-season cohort study. Knee Surg Sports Traumatol Arthrosc. Sep 26 2007;epub ahead of print. [Medline].

  8. McHugh MP, Tyler TF, Mirabella MR, Mullaney MJ, Nicholas SJ. The effectiveness of a balance training intervention in reducing the incidence of noncontact ankle sprains in high school football players. Am J Sports Med. Aug 2007;35(8):1289-94. [Medline].

  9. Kofotolis N, Kellis E. Ankle sprain injuries: a 2-year prospective cohort study in female greek professional basketball players. J Athl Train. Jul-Sep 2007;42(3):388-94. [Medline]. [Full Text].

  10. Stasinopoulos D. Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players. Br J Sports Med. Apr 2004;38(2):182-5. [Medline].

  11. Quinn K, Parker P, de Bie R, Rowe B, Handoll H. Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev. 2000;2:CD000018. [Medline].

  12. Bridgman SA, Clement D, Downing A, et al. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J. Nov 2003;20(6):508-10. [Medline].

  13. Rubin A. Ankle ligament sprains. In: Sallis RE, Massimino F, eds. ACSM's Essentials of Sports Medicine. St Louis, Mo: Mosby Year-Book; 1997:450-2.

  14. Arnold BL, Docherty CL. Bracing and rehabilitation--what's new. Clin Sports Med. Jan 2004;23(1):83-95. [Medline].

  15. Löfvenberg R, Kärrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. Jul-Aug 1995;23(4):414-7. [Medline].

  16. Plint AC, Bulloch B, Osmond MH, et al. Validation of the Ottawa ankle rules in children with ankle injuries. Acad Emerg Med. Oct 1999;6(10):1005-9. [Medline].

  17. Leddy JJ, Smolinski RJ, Lawrence J, Snyder JL, Priore RL. Prospective evaluation of the Ottawa Ankle Rules in a university sports medicine center. With a modification to increase specificity for identifying malleolar fractures. Am J Sports Med. Mar-Apr 1998;26(2):158-65. [Medline].

  18. Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa ankle rules. JAMA. Mar 16 1994;271(11):827-32. [Medline].

  19. Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. Apr 1998;17(2):375-92. [Medline].

  20. McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Nov 2 1998;105(5A):3S-9S. [Medline].

  21. Kayali C, Agus H, Surer L, Turgut A. The efficacy of paracetamol in the treatment of ankle sprains in comparison with diclofenac sodium. Saudi Med J. Dec 2007;28(12):1836-9. [Medline].

  22. Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. Nov 2007;35(11):1833-8. [Medline].

  23. Kaikkonen A, Hyppänen E, Kannus P, Järvinen M. Long-term functional outcome after primary repair of the lateral ligaments of the ankle. Am J Sports Med. Mar-Apr 1997;25(2):150-5. [Medline].

  24. Rosenbaum D, Becker HP, Sterk J, Gerngross H, Claes L. Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability. Foot Ankle Int. Dec 1997;18(12):765-71. [Medline].

  25. Tohyama H, Beynnon BD, Pope MH, Haugh LD, Renström PA. Laxity and flexibility of the ankle following reconstruction with the Chrisman-Snook procedure. J Orthop Res. Sep 1997;15(5):707-11. [Medline].

  26. Quillen WS, Magee DJ, Zachazewski JE, eds. The process of athletic injury and rehabilitation. Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:3-8.

  27. Meana M, Alegre LM, Elvira JL, Aguado X. Kinematics of ankle taping after a training session. Int J Sports Med. Jul 5 2007;epub ahead of print. [Medline].

  28. Anderson DL, Sanderson DJ, Hennig EM. The role of external nonrigid ankle bracing in limiting ankle inversion. Clin J Sport Med. 1995;5(1):18-24. [Medline].

  29. Sitler M, Ryan J, Wheeler B, et al. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. A randomized clinical study at West Point. Am J Sports Med. Jul-Aug 1994;22(4):454-61. [Medline].

  30. Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med. Sep-Oct 1994;22(5):601-6. [Medline].

  31. Rovere GD, Clarke TJ, Yates CS, Burley K. Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med. May-Jun 1988;16(3):228-33. [Medline].

  32. Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Med Sci Sports. 1973;5(3):200-3. [Medline].

  33. Ottaviani RA, Ashton-Miller JA, Kothari SU, Wojtys EM. Basketball shoe height and the maximal muscular resistance to applied ankle inversion and eversion moments. Am J Sports Med. Jul-Aug 1995;23(4):418-23. [Medline].

  34. Barrett JR, Tanji JL, Drake C, et al. High- versus low-top shoes for the prevention of ankle sprains in basketball players. A prospective randomized study. Am J Sports Med. Jul-Aug 1993;21(4):582-5. [Medline].

  35. [Best Evidence] Cooke MW, Marsh JL, Clark M, et al, on behalf of the CAST trial group. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess. Feb 2009;13(13):iii, ix-x, 1-121. [Medline]. [Full Text].

  36. Lephart SM, Pincivero DM, Rozzi SL. Proprioception of the ankle and knee. Sports Med. Mar 1998;25(3):149-55. [Medline].

  37. Lohrer H, Alt W, Gollhofer A. Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med. Jan-Feb 1999;27(1):69-75. [Medline].

  38. Manfroy PP, Ashton-Miller JA, Wojtys EM. The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance of ankle inversion. Am J Sports Med. Mar-Apr 1997;25(2):156-63. [Medline].

  39. Osborne MD, Rizzo TD Jr. Prevention and treatment of ankle sprain in athletes. Sports Med. 2003;33(15):1145-50. [Medline].

  40. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. Jan-Feb 1997;25(1):130-7. [Medline].

  41. Verhagen E, van der Beek A, Twisk J, et al. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. Sep 2004;32(6):1385-93. [Medline].

  42. Braun BL. Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation. Arch Fam Med. Mar-Apr 1999;8(2):143-8. [Medline]. [Full Text].

  43. Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. Oct 1998;19(10):653-60. [Medline].

  44. Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. Nov 1965;47(4):678-85. [Medline]. [Full Text].

  45. Bosien WR, Staples OS, Russell SW. Residual disability following acute ankle sprains. J Bone Joint Surg Am. Dec 1955;37-A(6):1237-43. [Medline].

  46. Balduini FC, Tetzlaff J. Historical perspectives on injuries of the ligaments of the ankle. Clin Sports Med. Mar 1982;1(1):3-12. [Medline].

  47. Bassett SF, Prapavessis H. Home-based physical therapy intervention with adherence-enhancing strategies versus clinic-based management for patients with ankle sprains. Phys Ther. Sep 2007;87(9):1132-43. [Medline].

  48. Garrick JG. Epidemiologic perspective. Clin Sports Med. Mar 1982;1(1):13-8. [Medline].

  49. Handoll HH, Gillespie WJ, Gillespie LD, Madhok R. Moving towards evidence-based healthcare for musculoskeletal injuries: featuring the work of the Cochrane Bone, Joint and Muscle Trauma Group. J R Soc Health. Jul 2007;127(4):168-73. [Medline].

  50. Hassan AH. Treatment of anterolateral impingements of the ankle joint by arthroscopy. Knee Surg Sports Traumatol Arthrosc. Sep 2007;15(9):1150-4. [Medline].

  51. Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports. Aug 2007;17(4):400-7. [Medline].

  52. [Best Evidence] van Rijn RM, van Os AG, Kleinrensink GJ, et al. Supervised exercises for adults with acute lateral ankle sprain: a randomised controlled trial. Br J Gen Pract. Oct 2007;57(543):793-800. [Medline].

  53. Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. Jul 2007;35(7):1197-207. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

ankle sprain, sprained ankle, twisted ankle, ankle injury, rolled ankle, anterior talofibular ligament sprain, deltoid ligament sprain, high ankle sprain, lateral ankle sprain, medial ankle sprain, syndesmosis sprain, turned ankle

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.