Ankle fracture - initial therapy program

Ankle fractures are a relatively common occurence not only amongst the physically active or athlete population, but also in the general population. Ankle joint, as a part of the foot region, is a transition point between the distal part of lower leg and the foot and loads that cross daily over the ankle are significant. The ankle is a touching point of the tibia or shin bone, fibula or calf bone, talus or ankle bone and calcaneus or heel bone.

Ankle is built out of two joints, the upper and lower ankle joint. The upper ankle joint (articulatio talocruralis) connects the distal part of the lower leg, tibia and fibula, with talus and in this joint dorsal and plantar flexion is executed. The lower ankle joint, in which inversion and eversion are executed, consists out of two parts, the posterior (articulatio subtalaris) and the anterior ( articulatio talocalcaneonavicularis), which connects the ankle with the tarsal region of the foot. Ankle fractures happen during ankle joint eversion or inversion and the injuries most often occur in landings, when the foot is planted incorrectly on the ground, during deceleration or while stepping foward when the foot is not positioned properly on the ground and the active and passive joint stabilizers can not handle the force and load put on the ankle which leads to them giving down and the bones fracturing due to the excessive force/load. The most common situations during which ankle fractures occur are car accidents, falls, heavy object hit/fall on the ankle, wrong steps, overloading the joint.

Risk factors for ankle fractures include being overweight, use of inproper, old or low quality footwear, doing sports with often direction changes as well as changes in the height of center of gravity, sight problems, certain medical conditions (osteoporosis, neuropathy – muscle weakness).

The gravity of ankle fractures can vary, ie. they can be very small, where the fracture is barely visible, or they can extremely difficult where the fractured bones protrude through the skin surface. After an ankle fracture an intense pulsating pain, sweeling, hematoma at the location of the fracture, inability to stand or move the ankle, ie. inablity to bear loads on the injured leg and even cuts, open wounds or protruding bone fragments can be experienced.

Treatment depends on the gravity and location of the fracture, meaning that the treatment approach in lighter cases is mostly conservative and with the more difficult cases, where the fracture is bigger, the bone parts get more distanced from each otheror even fragmented, a surgical approach is used and the bones are connected by use of a wire, plate, rod or a screw so that it could be stabilized and heal faster and better. At the start of the rehabilitation immobilisation is put on the injured ankle and the leght of its use depends on the type, location and gravity of the fracture. After the immobilisation is taken down, when the bones have completely healed,  gradual ankle mobility,  lower leg and foot muscles strenght and ankle balance exercises are implemented.

Prevention: choice of quality and correct footwear depending on sports activity or job description, maintaining a balanced body weight, aknle joint strenght and balance prevention programs, taking care of sight problems if there are any, etc.

Initial program

Used  during first 6 weeks post injury and it is based on physical therapy methods which help relieve the pain, swelling and hematoma. Gradually and progressively ankle mobility exercises and strenght exercises (static – isometric exercises) of lower leg and foot muscles are implemented.