Range of Motion Exercises for Ankle Fracture - About Recovery and Rehabilitation

Introduction:

A fracture is defined as a break in the continuity of the bone due to direct and indirect trauma. Sometimes it can be due to an underlying disease, and in such cases, it is called a pathological fracture.

What Are the Causes of Ankle Fractures?

Causes of fracture can be a direct blow to the ankle or a twisting injury. Sports injuries and road traffic accidents have been the main cause of fractures. Missteps and falls have also contributed to fractures in young children and older adults.

What Are the Symptoms?

• Pain is a consistent symptom present in almost all fractures.

• A swelling may be present localized at the site of fracture.

• An obvious deformity is seen if the fracture causes dislocation. Sometimes, it might be masked due to the presence of edema.

• There will be a functional deformity and loss of mobility near the fractured site.

• The patient finds difficulty in weight-bearing activities with the fractured ankle.

• Muscular spasms and tightness will be seen near the fractured site.

How Is It Diagnosed?

A thorough history containing information about recent trauma can help diagnose fractures. An X-ray is taken to identify the type and extent of the fracture. CT (computed tomography) scan may always be not required for fracture diagnosis. But it can be used for treatment purposes as it can give minute details about the fracture. MRI (magnetic resonance imaging) scan is done to picture soft tissue changes such as edema, hematoma, and effusion.

What Are the Treatment Options?

Treatment of fracture involves three stages:

1. Stage I: Reduction of fractured bones.

2. Stage II: Immobilization of a reduced fracture.

3. Stage III: Mobilization of the fractured joint and the limb.

Reduction:

The aim of the reduction is to achieve perfect anatomical alignment and restore the length of the bone. The reduction can either be done open (alignment can be achieved by surgery) or closed (alignment can be done by manipulation alone). In unstable and displaced fractures, open reduction followed by internal fixation is made.

Immobilization:

Maintaining or holding the reduced bone is important and is achieved through immobilization. Immobilization can be achieved in the following ways:

1. Traction: It exerts an axial pull while the counter traction localizes the traction effect. Counter traction is provided by gravity or a splint.

2. Plaster of Paris Cast: It is the standard method for immobilization, and a plaster cast is placed with one joint above and one joint below the fractured bone. Immobility and the development of edema are the disadvantages of this method.

3. Functional Cast Bracing: This allows movement of the joint and helps in remodeling the tissues during immobilization.

4. Internal Fixation: It is done through various implants such as screws, plates, and nails.

5. External Fixation: It is the best method for treating an open or compound fracture with severe tissue damage. This method stabilizes the fractured bone, allows wound healing, and permits surgical procedures to be done.

Mobilization and Rehabilitation:

This is the final stage of fracture healing. The main aim of this phase is to restore mobility and make the person independent physically. Specialized exercises and training for functional independence will be provided by the physiotherapist. Hot and cold therapies are given to the patient for pain relief and effective healing. The physiotherapist includes a few sets of exercises in the mobilization phase to improve the range of motion and restore the lost function of the limb.

What Are the Exercises Done for Improving Range of Motion?

1. Ankle Pumps: Lie down on a flat surface or on a bed with the feet hanging outside of the bed. Slowly bend the foot up and down at the ankle as far as it is comfortable. Repeat this exercise ten sets three times a day.

2. Ankle Circles: Sit straight on a chair with both feet flat apart on the floor. Now slowly rise the affected foot above the floor and move the ankles in a circular manner for five to ten seconds. Repeat the same in the reverse direction and do both sets for ten sets three times a day.

3. Ankle Inversion and Eversion: Lie down on a flat surface or on a bed with the feet hanging outside of the bed. Slowly bring both ankles towards each other, bending inwards and then outwards. Repeat this exercise ten sets three times a day.

4. Calf Stretch With a Towel: Sit on the floor with the knees extended and straight on the floor. Use a towel to hook under the affected foot and try pulling it back until a stretch is felt in the calf area. Hold the stretch for 20 seconds while keeping the knee straight. Repeat this exercise three sets thrice a day.

5. Standing Calf Stretches: Stand near a chair or bed and place both hands on the surface of the bed. Now lean with the unaffected leg forward and the affected leg behind until a stretch is felt in the calf. Hold this stretch for 20 to 30 seconds and repeat this exercise thrice a day.

6. Dynamic Ankle Dorsiflexion: Stand near a wall with the affected foot near the wall and the unaffected foot behind. To improve the dorsiflexion, start flexing the knee gradually to touch the wall with the heel lying flat on the floor. Now move the foot back slightly until a challenging stretch is felt. Repeat this 10 to 20 sets.

7. Standing Heel Raises: Stand behind a chair, holding the rail of the chair with both hands. Now slowly raise both feet with the toes touching the floor. In progress, it can be advanced to a single leg raise of the affected foot.

8. Romberg Stance: Stand with one leg near a bed or sturdy object. While standing, try to balance the position and also cross the arms over the chest. When there is a loss of balance, the hands can be loosened to hold something for support. To make this exercise harder, closing the eyes and moving the arms are recommended.

9. Toe Walk: This exercise is done to improve strength and balance. Toe walking with the heel upwards can be done in the forward and backward direction for a few minutes.

10. Walking Practice: Try to walk normally even if the balance is less; avoid using a crutch. Slowly, the dependence on the crutches will reduce, and limping may be seen during the start of walking. But on progression, there will be complete walking independence.

Conclusion:

An ankle fracture can limit the mobility of the patient and can make the individual dependent. Ankle exercises are done to improve the range of motion and assist in wound healing as well. These exercises help manage pain as well as strengthen the bones and joints. The strengthening exercise also helps prevent future risk of ankle injuries. The exercise and conditioning program will allow the individual to return to daily activities without any assistance.