An ankle injury can be a difficult journey to rehabilitate from due to a patient’s inability to sufficiently offload the joint or give the ankle enough down time to properly heal. I have currently a patient that injured his ankle by jumping off of an embankment on the side of the road and landed awkwardly in a pothole causing a violent dorsiflexion moment at the ankle injuring the deltoid ligament, ATFL, and CFL. The injury occurred 4 months earlier and the patient is still experiencing severe pain and swelling on a daily basis. Because of the patient’s job working in construction, he has not been able to stay off of his foot long enough to allow sufficient healing. He underwent an X-Ray and MRI both of which were negative for fracture (showed near full thickness tearing of the deltoid, CFL, and ATFL) and his physician wants to trial PT under the premise that if conservative approaches fail then surgical intervention would be the next step.
Going through the eval with this patient was difficult because the patient was still experiencing significant pain, was frustrated with being out of work, and has been convinced that PT isn’t going to work for him. I think part of his distaste for PT stems from a poor experience that he had for his low back in the past and partially from the conversation that he had with his physician saying that surgery is likely the course he is going to have to take. This made for an uphill battle for me as I can barely touch the medial/lateral aspect of his foot without significant pain. I also felt like I had to unroot his mentality that PT isn’t going to help which was difficult to take on. He was clearly frustrated that his ankle is not close to being back to its prior level and was not receptive when I asked to go back to using the crutches as this interferes with his daily life and makes work that much more difficult for him. I felt like I was walking a fine line with the patient as I don’t want to discourage his decision making if he wants to have reconstructive surgery for his ankle, but instead discuss and explain the benefits PT can have for his ankle. This was a difficult conversation as I think it is important to endorse and support the decision making of the patient, but at the same time try to sell PT if you truly think it can be of benefit and try to persuade the patient to give PT another shot despite a negative experience he may have had in the past.
Luckily the patient agreed to trial PT and go back to using crutches for the short term as we try to calm down and modulate the symptoms before engaging in balance and proprioceptive exercises to try to restore function to the ankle. I hope the patient returns to see me and gives an honest effort for PT and I am prepared to endorse the surgical route if it appears that the patient is not making any progress under my care.