Saturday, November 27, 2010

Ankle Exercises & Cse Study of Fracture of Both Bone Right Leg Distal Third


A 24 yrs old male patient came with chief complain of pain and swelling in right ankle foot. The patient had a history of Fracture of Both Bone Right Leg Distal Third three months before that was fixed through intramedullary nailing of tibia and the fibular maaleolus fixed with a screw. The patient had limited ROM at right ankle and foot. He had also difficulty in walking and prolonged standing (weight bearing activities).

Aims of Physiotherapy Treatment:
1.                  Reduce Pain
      Reduce Oedema
2.                  Increase the ROM
3.                 Improve walking and ADL’s
Assessments:
1.                Pain on VAS
                               At rest:                       6
                      On Activity:                       8
2.                 Oedema                                                  rt                                             lt
                      At ankle                                 10.5                                         9
                      5 cm Above ankle                9.5                                           9.5
3.               ROM
                     Dorsiflexion:             200      
                     Plantarflexion:          200
                     Eversion:                   100
                     Inversion:                  150                  
4.      Manual Muscle Testing
                    Dorsiflexion:             4+
                    Plantarflexion:          4+
                    Eversion:                   4
                    Inversion:                  4
Treatment:
    1st week:
        i.                                        Paraffin wax Bath2:               15 minutes     (brushing method - 8 coats)           
     ii.                                      Active Assisted ROM exercises:    10 rep each on ankle and feet exercisers
2nd week:
        i.                                     Paraffin wax Bath:                15 minutes     (brushing method - 8 coats)
     ii.                                     Resistance exercises using theraband (initial 3 days)1,5:
Dorsiflexion:             10 rep
            Plantarflexion:          10 rep
            Eversion:                     6 rep
            Inversion:                    6 rep
After three days of 2nd week the the strengthening exercises are progressed to 3 sets of ten rep and 2 more exercises r added i.e.
   iii.                                                         Calf Stretch
   iv.                                                         Balancing on a pillow with open eyes
Outcome:                               Initial             After two weeks       Difference
1.      Pain on VAS
                  At rest:                       6                      2                                  4
      On Activity:                          8                      3.5                               4.5
2.      Oedema                                                                                
                At ankle                     10                      9                                  1
               5 cm Above ankle      9.5                   9.5                                0
3.      ROM
                Dorsiflexion:             200                   250                                     50
                Plantarflexion:          200                   250                                         50
                Eversion:                   100                   150                                         50
                Inversion:                  150                   200                                         50
Discussion:
Initially the patient had limited ROM with existence of pain and discomfort. After giving the physiotherapy treatment for 2 weeks there is significant improvement in joint ROM, pain and swelling.
After 2 weeks the patient discontinues the regular physiotherapy treatment and home advices are given to patient which include continue active assisted exercises of ankle and foot and contrast bath.









References:

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