Miss X is a 16 year-old soccer player who presented 6 weeks after right ankle surgery for a fracture whilst playing soccer. After 6 weeks in a boot and using crutches before she attended physiotherapy. At this stage there was good movement in all directions of the ankle (approx. 80%) but significant wasting and weakness in the calf muscle. A measure around the mid-point of the calf showed 3cm less circumference on the injured side. Studies have shown that reduced circumference represents a loss of strength in the muscle. She was instructed to gradually wean out of wearing the boot over several weeks. At her first appointment, she was able to walk a short distance, slowly without the boot pain free. Her goal was to return to soccer as soon as safely possible.
The focus of rehabilitation in the first 2 weeks was to regain full ankle movement and to commence a strengthening program. We measured the strength of the ankle using a hand held dynamometer. Miss X had less than 50% strength in her right ankle muscles compared to the left side. The strength program started with high load for the hip, gluteal and core muscles, which were weaker after not putting any weight on the leg for 4 weeks. Ankle specific exercises started gently with theraband and then progressed quickly into weight bearing strengthening; as the ankle was able tolerate the load. There was also a significant difference in Miss X’s single leg balance between sides. Her arch dropped down when standing on the right leg, but didn’t on the left. Specific exercises, such as toe scrunching and arch lifting exercises were added to the balance program. After 3 weeks of physiotherapy, Miss X was saw her orthopaedic specialist and was able to remove the boot and walk comfortably wearing a lace up ankle brace.
The full orthopaedic clearance for return to sport was provided at 12 weeks post-surgery. At this time, Miss X was allowed to start a graded return to running program. Based on her progress so far, it was predicted that Miss X would be able to commence full team training after another 6 weeks of sport-specific rehab. Over this next period, her program consisted of single leg squatting exercises, multidirectional hopping drills, straight line running, then change of direction and a gradual return to striking the ball. Miss X was guided gradually towards 100% of her pace and intensity at training and slowly introduced to contact drills and full team training. The ankle was monitored after sessions and no soreness / swelling presented afterwards or the next morning. Miss X was motivated to return to her high level of sport and was provided with a safe pathway to do so in the most efficient time possible. She achieved a safe returned to full, unrestricted football.
If you have injures your ankle with sport, we can help you. Contact us on 49216879.