fracture rehabilition

[cute sara]

If we had a young patient who had isolated fibular fracture 8 weeks ago and the cast was removed 2 weeks ago . She has decrease range of motion in doriflexion and plantarflexion , limping gait , stiff ankle, no heel strike ,loss of normal toe off , and she has grade 4 dorsiflexor , plantarflexor and quadriceps muscle strength.

I decided to use,Active free exercise, passive stretch , PNF(hold-relax) , and resisted exercise for plantar and dorsi flexion .

What do you think about my single intervention session?

Is it ok to use passive stretch and PNF at the same session or can i take out one of them ?

Do you think that i have to add quadriceps strength to my first session ?

I am looking forward to hearing from you

[Canuck Physio]

Has a neurological assessment been completed, or is there any pain, abnormal sensation? Or has this been ruled out by the Consultant? Have you tested this yourself?

It may be worth examining sensation and proprioceptive response, and consider these to that the patient may more actively be involved in re introducing normal movement.

Just a suggestion

[cute sara]

she does not have any abnormal sensation but she has:

-decrease ROM in dorsi and plantar flexion.
-reduce stance phase ( shortened stride length)
-thickening around the lateral malleolus
-tending to stand with wieght through the Rt leg and rest her Lt leg out in front of the -Rt leg , resting on the forefoot
-reduce ms bulk on the Lt ( site of fracture)

what do you think about the intervention that i choose?

and what about the warm up can i use the free active free exercises as warm up or i do 20 min walking on treadmill beside the free active exercise?

[hariharan]

i dont accept reducing muscle bulk. but reducing stance phase and making to stand with wieght through the Rt leg and rest her Lt leg out in front of the -Rt leg , resting on the forefoot is an intelligent cocept. well said.

[alophysio]

Sorry hariharan but are you suggesting they persist with the altered pattern?

I would get this person walking as normally and as often as possible. No matter how long your treatent session is with them, it will never be as long as what they have to do when you are not there.

You have not mentioned any pain at all therefore i would pursue this line (make them walk).

You mention that she is young - how young is young?

Also, the more passive treatment you give her, the more she will think she needs you to help her.

To be honest, her symptoms sound like a typical stiff ankle following immobilisation. It just needs to get moving. Your role should be to give her the confidence she needs to use the ankle again.

Lastly, it is a fibular fracture - assuming no other damage like talar dome osteochondral lesion etc. Therefore get her going on it and make her do it. Get tough!

Hopefully this advice isn't too shocking. Obviously i don't have all the information or done an assessment but just getting her going as much as possible on it.

Good luck!