Ankle fractures: What can help get you back on your feet again?
Using a removable brace or splint and starting gentle exercises or physiotherapy within days of ankle fracture surgery can have short-term benefits. But moving the ankle too soon can also cause problems with wound healing.
When people twist their ankle, their upper ankle ankle sometimes breaks (ankle fracture). This is a more serious injury that also affects your shinbone and/or calf bone. The ligaments are then often torn too, and cartilage may be damaged. The foot and ankle become swollen, painful and can no longer hold any weight. It takes several days or weeks for the swelling to go down completely, and can take months for the ankle joint to fully recover from the fracture.
Research on the effectiveness of rehabilitation interventions
Researchers from the Cochrane Collaboration – an international network of researchers – wanted to find out which forms of rehabilitation best improve recovery from an ankle fracture. For example: When should you start moving and putting strain on the ankle again? What are the best ways to do this? Could treatments such as electrotherapy or hypnosis help?
To find out which interventions could help could help people move their ankle again sooner, and how they compare with other treatments, the researchers looked for studies known as randomized controlled trials. The Cochrane researchers included a total of 38 studies in their analysis. But some of the studies involved very few participants and were not designed or carried out well. This makes their conclusions less reliable. The participants were men and women of all ages. The individual studies looked at the advantages and disadvantages of
- Interventions done during the immobilization phase (while the ankle was kept still): When looking at these studies, the researchers did separate analyses for people who had ankle surgery before the ankle was immobilized and people who did not. The interventions that were studied included different types of splints as well as hypnotherapy.
- Interventions done after the immobilization phase: These studies looked at interventions such as physiotherapy, stretching or electrotherapy. The interventions were only started once the splint, brace or cast had been removed. Some of the people in these studies had had surgery, others had not.
Interventions during immobilization
Three studies looked into the question of which conservative (non-surgical) interventions help best. In two of the studies, two different kinds of splints were compared to see whether they had any pros and cons. The third study compared hypnotherapy with physiotherapy. Physiotherapy is the standard treatment for ankle fractures. The research results did not show any clear differences between these interventions.
Thirty studies looked at various interventions after surgery, such as wearing a brace or splint, sometimes also combined with either exercises or electrotherapy. It's not possible to assess the advantages and disadvantages of all of the interventions because many of the studies were very small and some of them compared very different treatments.
Ten of these studies looked into how effective exercises were when done at an early stage. They suggest that the ankle becomes more mobile again somewhat sooner in people who wear a removable brace or splint after surgery and start doing exercises sooner. Doing exercises earlier also lowered the risk of thrombosis. In some studies, participants who had removable braces or splints were also able to get back to everyday activities sooner than participants who wore non-removable splints and started the exercises later. But both groups of participants were similarly active and mobile by the end of the studies.
Moving the foot soon after surgery also led to minor problems, though – usually associated with wound healing.
- Without early physiotherapy, about 7 out of 100 participants had these problems.
- The participants who had early physiotherapy started doing gentle exercises a few days after surgery. Of those people, about 16 out of 100 had these problems.
In other words, about 9 out of 100 participants had problems because they started moving their ankle sooner. But serious adverse effects like new ankle fractures were rare.
Interventions done after the immobilization phase
Five studies looked at whether particularly intensive physiotherapy – combined with stretching, electrotherapy or exercises – has any advantages over conventional physiotherapy. None of these approaches made the joint more mobile than conventional physiotherapy did. The studies included both people who had had surgery and people who had not.
Keene DJ, Williamson E, Bruce J, Willett K, Lamb SE. Early ankle movement versus immobilization in the postoperative management of ankle fracture in adults: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2014; 44(9): 690-701.
Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2012; (11): CD005595.
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