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 Pains & Aches

January 2012
Physiotherapy After Ankle Injury
Dr Vijay K Krishna
 
Ankle bears the maximum weight of the whole body, during walking and standing. Ankle mortise
or joint is vulnerable for most of the twist injuries. Soft tissue injuries and hairline fractures are the common injuries that occur at and around the ankle.

Untreated fractures or mal-union of fractures can lead to fused joints in the long run. Hence, an early rehabilitation to meet the goals charted by a physiotherapist is mandatory for any injury occurring at and around the ankle joint.

Common Ankle Injuries
Soft tissue injuries: sprains occur commonly at medial collateral ligament (Deltoid ligament), lateral collateral ligament. There are three grades in any ankle sprain:
  • Grade 1: stretching of the ligament; pain and swelling; patient can walk without support
  • Grade 2: severe partial tear of the ligament; swelling and bruise; pain with walking
  • Grade 3: complete tear of the ligament; painful ankle; difficulty in walking; instability or giving away feeling is observed
Ankle rehabilitation is focussed depending on the timeline of the injury:

Acute (immediately)
Sub-acute (day 3 – day 14)
Early rehab (week 3) Late rehab (week 4 – week 5)
Functional rehab (week 6 and above)

Bone involvements
Fractures / dislocations: These can occur when there is a significant force applied either directly or indirectly; results in loss of connectivity with the articular surfaces.
  • Lateral malleolus fracture
  • Medial malleolus fracture
  • Posterior malleolus fracture
  • Bimalleolar fractures
  • Trimalleolar fractures
The duration of treatment of an ankle fracture is related to the associated soft tissue involvement, location and type of fracture. In any case, the main focus of rehabilitation should emphasize restoring full range of motion:
  • Strength
  • Proprioception
  • Endurance while maintaining independence in all activities of daily living

Goals of physiotherapy
  • Implement PRICE (Protection Rest Ice Compression Elevation)
  • To protect and prevent further injury to the ankle where a crepe bandage
  • Decrease swelling - by using ice and elevation of limb
  • Decrease pain – by using ice packs
  • Stretching calf muscle
  • Strengthening exercises of ankle
  • Restore full Range of motion (especially attaining dorsiflexion)
  • Gait training – walking with walker, to crutches, to cane, to full weight bearing finally
    returning to activities
  • Balance training/proprioception
Exercise regimen that can be followed(in most of the cases)
  • Ice application for pain relief and to reduce swelling
  • Isometric exercises for ankle musculature – invertors, evertors, dorsiflexors, and
    plantarflexors
  • Range of motion exercises – moving the joint in anatomical planes within pain free ranges - leg swings, toe raises, toe taps
  • Towel exercises for toes – towel scooping, towel scrunches
  • Wind shield wiper exercises for inversion and eversion
  • Stretches – gastrocnemius, soleus, anterior tibialis stretch
  • Strengthening exercises – seated calf raise, single leg stand, isometrics of evertors
    and invertors followed by progressive calf strengthening exercises. Tubes and
    resistance bands are a part of the progressive strengthening techniques
Warning!
Please note that this is not a standard protocol for ankle rehab especially after fractures. You must consult your physiotherapist for a specialised regimen based on
the complaints.


    
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