Presentation:
16 y/o male presented with acute left sided ankle pain and swelling after rolling his ankle at Oz-tag the night prior. He was unable to continue playing. He went straight home and iced his ankle while in an elevated position.
He explains he has rolled his ankle in the past, but not for 3-4 years.
At the moment he does not feel confident enough to weight bare unassisted.
Examination:
Observation; obvious signs of swelling and early stage discolouration around the lateral ankle and into the dorsum of the foot.
Postural analysis; towering to the right to avoid pressure through the left ankle.
Gait analysis; unable to ambulate unassisted
Palpation; hypersensitive along the lateral ligaments and peroneal tendons.
Palpation; sensitive along the lateral edge of the 5th metatarsal base.
Range of motion; Plantar Flexion = 10 – 20 deg. Dorsiflexion = 0 – 10 deg. Inversion = 0 – 5 deg. Eversion = 0 – 10 deg.
One leg standing proprioception test; Left = 4 seconds. Right = 11 seconds. This was tested at the start of week 2.
Suggest an X-ray of the foot to exclude an avulsion fracture of the 5th metatarsal base
Imaging Report;
No fractures.
Joint effusion.
Treatment:
Education & Advice.
Myofascial therapy.
Talotibial joint mobilisation.
Talocalcaneal joint mobilisation.
Kinesiology taping techniques.
Proprioceptive exercises.
Home Exercise:
Ice Therapy
Dorsiflexion and plantarflexion active mobility (from the start of week 2)
Circumduction active mobility (from the start of week 3)
One leg standing balance exercises (from the start of week 2) with associated progression over 4 weeks.
Outcome:
After 5 consultations by the end of week 2, the patient showed a 65% mobility improvement.
After 8 consultations by the end of week 4, the patient reported one leg standing test results of; Left = 38 seconds. Right = 45 seconds.
After 12 consultations by the end of week 8, the patient showed unrestricted mobility, full strength and stability.
He has returned to playing Oz-tag on a bi-weekly basis with the use of rigid taping as a preventive measure.
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