The ankle is a load-bearing joint and is subject to frequent traumatic injuries. Anatomically, it articulates three bones in a joint capsule. The joint is strengthened statically by ligaments and dynamically by muscles. Correct arthrokinematics depends on the normal functioning of these structures. As a load-bearing joint, it is affected by dysfunctions at the level of the pelvis, which affect the way of stepping and the distribution of weight on the foot. Traumatic ankle injuries can occur in routine activities of daily living. And to risky sports activities we can include activities related to a sudden change of direction /tennis/, with object manipulation /football/, with landings /ballet, volleyball/, etc. The occurrence of an ankle fracture is a severe trauma that violates the integrity of bone structures.
Trauma mechanism, clinical picture, treatment approach
An ankle fracture occurs in:
- with an in-out twisted foot in an abnormal range of motion in the joint. This mechanism of injury can occur with or without weight bearing.
- under the influence of external high-energy forces acting directly on the ankle.
The clinical presentation is variable and depends on the severity and mechanism of injury, as well as the affected structures. There is pain, swelling, limited range of motion, inability to step, unnatural shape of the ankle, etc. Diagnosis and treatment is carried out by a specialist orthopedist and includes x-rays from different positions.
Once an ankle fracture is diagnosed, treatment can be either conservative or operative. Beneficial fractures undergo conservative treatment and immobilization. Operative interventions are inevitable in case of impaired integrity of the joint and instability. They use metal osteosyntheses with the aim of bone stabilization with subsequent healing. At the operator’s discretion, they may be removed after a few months. Regardless of the treatment approach, the immobilization required for bony union to occur causes damage locally to the joint and the entire lower limb. Rehabilitation plays an important role here. Its launch begins after permission from the attending physician, who monitors healing.
Physiotherapy and rehabilitation for ankle fracture
A primary goal of ankle fracture mobilization is maximal functional recovery. The tasks to be solved are related to reducing edema, improving skin mobility and cicatrix, increasing the range of motion in the ankle joint, normalizing the length and gliding of the adaptively shortened Achilles tendon, strengthening the muscles for better joint stabilization and maintaining the vaults. The attention of the kinesitherapist should not be directed only locally, but also to adjacent joints negatively affected by walking with crutches and sparing the limb. The means for solving these tasks are: cryotherapy, anti-edema massage, joint mobilizations for the bones of the foot, exercises for volume, strength, mobility, balance. Throwing away the crutches is done gradually by going through the transition of walking with one crutch. Gradually, the limb is burdened until the gait is normalized. The exercise program is gradually expanded and complicated until normal functionality of the affected limb.
