Case Study – Ankle Injury? Walk Right Back.

June 24, 2013 | By READ MORE...

– Dr Atmi

Mr X came to PHYSIOREHAB with a complaint of:

  • stiff ankle
  • limp while walking
  • difficulty in climbing up-down stairs

Ankle

He was diagnosed with fracture of lower end of tibia fibula with displacement and dislocation of tibio-tala joint 6 weeks before he came to PHYSIOREHAB. This injury took place due to the fall he had from the back of a taxi. He had slipped and hit his foot against the road causing severe pain and deformity to his right ankle.

Ankle Injury

He underwent ORIF (Open Reduction Internal Fixation) with medial lateral screw plate fixation for tibia-fibula the next day after the fall. He was advised 6 weeks of non-weight bearing and gentle physiotherapy after 3 days.

Examination

Examination:

  • Tenderness (pain on touch) on the scar
  • Restriction of all ankle movement i.e. dorsiflexion, plantarflexion, invertion and eversion. Dorsiflexion could go only uptill neutral.
  • There was weakness in all the muscles around the ankle joint and buttock.
  • Tight calf muscles due to restriction of dorsiflexion.
  • Trigger points in calf muscles.
  • Balance on both the legs with eyes open and closed was good but on a single leg it was shaky.

Ankle FlexionImbalance

At PHYSIOREHAB we check the patient in a holistic manner, full biomechanical assessment was done from foot-knee-hip-back. We ruled out if he had a limb length discrepancy as he was limping.

In such a case a usual PHYSIOREHAB protocol would be to do ankle toe movements and mobilisation but we not only do mobilisation but also identify and use various new techniques like dry needling, soft tissue release and kinesio taping.

Treatment:

  • To improve the range:

Treatment
Mobilization: It is a passive skilled manual therapy technique applied to ankle joint and related soft tissue at varying speeds and amplitude.

  • To reduce Calf tightness:

Treatment
Dry Needling: Releases the trigger points and reduces the pain

Treatment
Calf Stretching

Treatment
Soft Tissue Mobilization(STM): Makes calf muscles supple and breaks the trigger points

  • To decrease swelling:

Treatment
Kinesio Taping

  • To improve strength & stability:

Treatment
Theraband

Treatment
Calf Training

Treatment
Balance & Proprioception

Treatment
Gait Training

Treatment
Stepper Work

After 6 weeks of treatment, stiffness at the ankle joint reduced considerably, he could walk without a limp, ankle strength improved and stair climbing was no more difficult. Now patient is kept on a maintenance programme.

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Category: Case Studies

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