The ankle joint fracture is a rather common fracture. The upper ankle joint consists of three bones: the fibula (fibula), the tibia (tibia) and the talus (anklebone). The lower ankle joint consists of the talus, the calcaneus (heel bone) and the os naviculare (scaphoid bone). When we speak of an ankle fracture, we usually mean the upper ankle joint.
5 simple exercises to imitate
1. exercise “early stage” 2. exercise “load-stable stage” 3. exercise mobility – “heel swing” 4. exercise mobility – “pronation/supination” 5. exercise “mobilization/loading “After an ankle fracture, the ankle joint is usually immobilized for some time. Although this allows the joint to heal, the stabilizing muscles atrophy (degrade) due to immobilization. If the joint is then loaded or exercised again, the muscles are often not able to stabilize the joint safely.
This has to be trained in the therapy to relieve the possibly unstable capsule ligament apparatus.
1. exercise (early stage) In early stages, after severe fractures, the foot should be trained only in the plantaflexion – extension of the foot and gently in the dorsal extension – lifting of the back of the foot, so as not to stretch the malleolar fork (brace between fibula and tibia). Lateral movement components such as lifting the outer edge (pronation) or the inner edge (supination) are only integrated into the training later.
The patient should perform the movement exercises actively. 2. exercise (load-stable phase) From the load-stable phase, i.e. when the patient is allowed to put his foot back under his body weight, training should be done in the closed chain. Training in a closed chain is when the foot is on the floor and the body weight is applied from above, as is physiologically the case when walking.
First of all, we practice the even distribution of weight on both feet, followed by a short one-legged stand by moving the healthy foot back and forth while the affected foot remains safely on the ground. The ankle joint must now compensate for the shift in weight caused by the walking movement of the healthy foot. Variation: If this can be done safely and painlessly, the exercise can be performed on different surfaces.
Soft mats, therapy spinning tops or similar are suitable. The load on the foot can then be increased, for example, by training in the lunge step, or – a very high coordinative requirement, in the one-legged stand. The patient can be distracted by certain stimuli if he can hold the position safely.
For example, he should bounce or catch a ball when standing on one leg. Further exercises for the ankle joint can be found in the articles:
- Exercises for ankle fracture
- Physiotherapy exercises ankle joint
- Torn ligament at the foot – what to do?
In addition to the increasing load, as soon as all movement directions – including lateral components – are released, the mobility of the foot should also be trained. Gymnastics for the arch of the foot round off the training.
1st heel swing For dorsal extension (pulling up the back of the foot) and plantaflexion (stretching the foot), the so-called heel swing from functional movement theory is ideal. The patient is in a long seat. The foot is stretched to the maximum.
From this position, the heel is fixed to the support, it should not move from this position during the exercise. To practice the dorsal extension, the patient pulls the back of the foot towards the shinbone. In order to reduce the angle in the upper ankle joint and to increase the movement, the knee must now be lifted, since the heel should not move on the surface.
Both joint partners now move towards each other, the angle in the joint becomes maximally small. For plantaflexion, the hollow of the knee is now pressed into the support and the foot stretched to its maximum length. Both joint partners move away from each other.
This is called abutting mobilization, a good technique to prevent evasive mechanisms and to exploit the maximum possible mobilization. The exercise should not be painful and should be only slightly strenuous. About 15-20 repetitions can be performed in three sets.
2. pronation/supination The lateral movement can be trained well while sitting on a stool. The foot is below the knee joint. If the patient now raises the outer edge, he can give himself a slight resistance at the outer knee with his hand.He tries to press the knee against the hand so that it cannot move inwards, or even moves slightly outwards.
The heel remains firmly on the ground. When lifting the inner edge of the foot, the patient now gives resistance on the inside of the knee. The exercise can either be performed several times on one side or alternately.
It should not be strenuous, but requires a certain amount of concentration. Here too, 15-20 repetitions in three sets must be performed. 3. mobilization under load In later stages after an ankle fracture, mobilization exercises under the influence of body weight can also be performed.
Large forward lunges while the rear foot and heel remain on the ground can be performed as well as lateral lunges. Here too, the supporting leg should remain on the ground so that lateral mobility is trained. The ankle joint of the supporting leg is trained.
Stretches for the calf muscles can round off the training program. More exercises can be found in the article: Mobilization ExercisesThe Balance Pad is a thin soft foam mat that is ideal for coordinative exercises. It can be used in individual therapy as well as in group therapy or at home.
Because the Balance Pad gives way to the weight, the patient must constantly stabilize his joint muscularly in order to maintain balance. It is a high demand on the joint, the musculature and also on the sensors which give the body its joint position (proprioception). The exercises on the Balance Pad are relatively simple to perform, but place high demands on the structures.
From a simple two-legged stand with slight weight shifts to lunges with one leg on the balance bath or the one-legged stand, there are no limits to your imagination. The training is effective, but should only be done when the exercises can be performed safely on solid ground. The Theraband is also suitable for training the muscles of the ankle joint after an ankle fracture.
1st exercise The Theraband can be tied around both lower legs or only around the affected lower leg and a table leg, or a solid object. Thus the Theraband pulls the lower leg inwards or outwards once. The ankle joint has to balance this pull to remain stable.
Variation: Now all kinds of exercises with the lower limb can be performed again. Knee bends, lunges (with the other foot), or even the one-legged stand. Again, if the exercises are mastered safely, distraction like a ball or changed ground like the Balance Pad can be used to make the exercise more difficult.
If the patient performs the exercises alone at home, he should at best do it in front of a mirror to check his leg axis independently. The exercise is demanding and should be performed in a controlled manner. Quality comes before quantity.
More exercises can be found under: Bimalleolar Ankle Fracture TreatmentThe classification of ankle fractures is according to Weber. Depending on the severity, one speaks of a Weber A, Weber B or Weber C fracture. In a Weber fracture, the fibula is affected.
The degree of severity depends on the height at which the bone is broken – below or above the so-called syndesmosis, a ligamentous connection between the two bones, the tibia and fibula. The fracture of the ankle bone is called talus fracture. Therapeutically, Weber C and usually also Weber B fractures require a stabilizing operation; Weber A can also be treated conservatively.
Since our ankle joint has to hold the entire body weight, the joint is heavily loaded. After a fracture, it is important to train the surrounding musculature in order to avoid further injuries – e.g. by bending over. In most cases, the ligaments of the ankle joint are also affected and unstable in an ankle fracture.
Physiotherapeutic strength and coordination training is essential to secure the joint. More information about fractures of the ankle joint can be found in the article: Exercises for an ankle joint fracture
- In Weber A fracture, the fracture line of the fibula is below the syndesmosis,
- In Weber B fracture, the fracture line is at the level of the syndesmosis,
- In Weber C fracture, the syndesmosis is also affected and the fracture above
Weber C fracture in particular is treated with a stabilizing operation, but Weber B fracture can also be operated on. This is usually followed by immobilization in a splint (aircast or similar) to relieve the joint.
Certain movement directions are initially prohibited. Especially the pulling up of the foot is difficult in case of injuries of the synesmosis (ligament connection between tibia and fibula), because the ankle bone presses itself into the malleolar fork and thus pushes the two bones and the ligaments apart. Lateral (lateral) movement components may also be prohibited initially.
The movement and load capacity are gradually released by the surgeon. Postoperative follow-up treatment usually includes lymphatic drainage in addition to physiotherapy. In lymphatic drainage, tissue fluid, which often accumulates after trauma, is drained into the lymph vessel system by gentle massage movements to reduce tissue pressure and create improved healing conditions.
After approx. 6 weeks, the mobility and resilience is usually released again. Exact times are given individually by the doctor.
