Posts tagged ankle injury
3 Week Immobilization Shown Equivocal To 6 Week For Some Ankle Fractures
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Ankle fractures are a relatively common traumatic orthopedic injury involving the two lower leg bones and ankle joint.  Among these fractures, the most common type involves a break of the outer lower leg bone (weber B).  These fibular fractures are commonly allowed to weight bear early than tibia fractures because they are less important for lower body weight bearing.  Common medical practice provides immobilization to avoid excessive weight bearing or forces for 6 weeks following fracture, but smaller studies have not demonstrated a significant increased risk of adverse events if fractures are immobilized for less than the standard 6 weeks.

A large randomized, controlled trial was published in the British Medical Journal documenting the effects of two types of non surgical management strategies for Weber B ankle fractures (Haapasalo et al. 2019).  Authors randomized 247 fibular Weber B, stable, ankle fractures to either a 3 week or 6 week immobilization period in an orthosis.  Patients were assessed on ankle function, pain, quality of life, ankle motion, and adverse events at 6, 12, and 52 weeks after the fracture.  Authors reported no difference in outcomes between the 3 or 6 week management groups except a slight improvement in ankle range of motion and deep vein clot risk in the 3 week group.  Patients are encouraged to speak with their orthopedist regarding the best course of action for their individual fracture management. 

Increased Ankle Stiffness Reduces Proprioception and Balance

Injuries to our spinal and extremity joints can impact a variety of structures including muscle, ligament, and nervous system receptors.  The sensors or proprioceptors are critical in providing real time feedback to our spinal cord and brain on the positions of our limbs.  This feedback system is disrupted by injury leading to slower information processing and in turn a loss of balance.  Most commonly this cascade is seen in patients with ankle sprain.  Without balance training and physical therapy our proprioceptive system remains impaired.

A recent study in the Journal of Orthopedic and Sports Physical Therapy (Rocha Marinho, H. et al. 2017) examined the proprioceptive and balance abilities of patients complaining of ankle joint instability and their uninjured peers.  The authors also evaluated the passive movement in the subjects ankles.  Consistent with previous research the patients complaining of ankle instability demonstrated the worst proprioception or balance.  Those with limited ankle mobility and higher levels of stiffness demonstrated reduced balance or proprioceptive ability.  This research highlights the importance of retraining the nervous system after joint and muscle injury.  
For more information on proprioception training contact your local Physical Therapist.