making life livable: 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:

1^st week:

i. Paraffin wax Bath²: 15 minutes (brushing method - 8 coats)

ii. Active Assisted ROM exercises: 10 rep each on ankle and feet exercisers

2^nd 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 2^nd 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 25⁰5⁰

Eversion: 10⁰ 15⁰5⁰

Inversion: 15⁰ 20⁰5⁰

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.