Ankle sprains and ankle fractures are a common part of physiotherapy practice. A repeated sprain can give difficulty walking on uneven surfaces or a chronic ankle pain problem. The subjective examination from the physio explores how the injury occurred, the amount of trauma involved, how much pain developed and whether the patient walked about afterwards. They may have attended an accident emergency department and been reviewed with an x-ray.
The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn’t settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the sunnybank physiotherapist later.
The physio will ask about previous injury to the area and the medical history of the patient, past medical conditions and medication. The physio will ask about appetite, loss of weight, quality of sleep, bladder and bowel function and relevant family history. The objective examination starts by looking at the appearance of the part for any any discolouration, swelling, skin damage or circulatory abnormality.
Examination protocols
Changes in the ankle such as colour, swelling or circulation are noted and then ankle movements are assessed without weight on the joint, including dorsiflexion (pulling the ankle upwards), plantarflexion (pushing the foot down), eversion (turning the foot outwards) and inversion (turning the sole of the foot inwards). The physiotherapist assesses ankle movements as pain limits movement and the readiness of the patient to engage in rehabilitation.
Depending on pain the physio may manually test the strength of the ankle muscles. This can occur on the plinth or up on their feet if the injury permits it. Once the active movements have been recorded, the physiotherapist performs passive movemenst of the joint, pushing carefully with their hands to explore stretch of the joint structures in each direction. The physio may manually palpate the area to test which structure is at fault, noting swelling or tenderness
Physiotherapy treatment
Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.
A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio’s hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support.
The brain monitors ankle position all the time, instructing the muscles to contract to prevent damaging positions. Rehab involves balancing on one leg, progressing to standing on a wobble board and then throwing and catching a ball. Balance and coordination retraining occurs until the ankle is good on rough ground and running and jumping. The ankle has recovered when pain has subsided, movements are good, strength has returned and the proprioception or sense of joint position has been restored.