Distal fibula fracture rehab

[barrs1985]

Hello,
a chap on a team that i cover is 5 weeks post distal fracture of fibula via impact on landing when jumping, slight fracture, had pott on for 3 weeks, then the last two weeks had pott changed and has open shoe on it and has not been using his crutches.
What are your views on him not using his crutches? He is walking fine without the crutches and fully weight bearing with the pott and open shoe type support but i cant help wonder if he still might be doing himself some damage by not using the crutches at times.

Also his pott is due to come off within the next two weeks. From my experience of treating ankle fractures, my rehab program for him will consist of regaining ROM with both active and passive exercises, strengthening exercises via calf raises and squats bilateral then progressing to unilateral, Gastro and soleus stretches and of course prorioception acutely, then progressing to jogging in straight lines and then turning and different planes with finally sprinting. My main objective is to get his proprioception better than what it was initially to avoid any reoccurance.

Is there anything else that other more experienced PTs do when treating ankle fractures with athletes that i have not yet come accross? Would be interested to hear.
Regards,
David.

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[karen.hankey]

Hi David,

I wouldn't worry about him not using the crutches as long as he is walking without a limp. The fibula is a non-weight bearing bone and so thats why it isn't in plaster for as long.

Your rehab programme sounds about right. Is the support he is using a the moment removable? If so i would start gentle mobilisations at this stage. As you say balance is the big thing to try and reduce further problems.

With the strength aspect, if the patient is tolerable and no pain start isometric exercises asap, then do it partial WB and move onto fully WB. When bilat heel raise, try and ensure they are not just using their good leg, but unilateral will find out the cheats.

Let us know how you got on.

[barrs1985]

Thanks Karen,
He is doing quite well at the moment, he has the cast off and not too much swelling,
His ROM is nearly equal again and his m/s is 4/5, the only thing that is noticeably a problem is his soleus msc is after shortening quite abit, his rehab is going quite well and i now have him light jogging with no pain.
I also have him on his bike quite abit cycling different terrains.
Although he reported been quite stiff the day after around the soleus muscle. He continues to stretch this quite alot and is getting back to normal slowly but surely.

My aim is to have him full sprinting by the end of this month (August).
His balance is quite good and has started balance and wobble board stuff now cos he is too advanced for closed eyes technique already.

Is my timescale for sprinting too close or far away do you think?

Regards,
David.

[karen.hankey]

Hi David,

I wouldn't let him sprint unless the stiffness when he jogs subsides. Make sure he is doing his soleus stretches properly (most people don't).

[barrs1985]

Cheers Karen, when you say properly, what are the most common mistakes that people make? I have him doing it with his foot as far away as possible from the wall and knee to wall and measuring how many fingers he can get his foot away.
David.

[karen.hankey]

When either Gastroc or Soleus are tight most people tend not to have their foot pointing forwards, it tends to point outwards.