HISTORY: A 21y/o male, Division III (D3) basketball player inverted his right (R) ankle during practice landing from a jump. The athlete felt a popping sensation over the lateral aspect of his R ankle, had immediate pain and the supervising athletic trainer (AT) evaluated him for major deformity. Unable to ambulate, he was transported to the athletic training room for further examination.
PHYSICAL EXAMINATION: Upon initial examination, no obvious deformity, swelling, or ecchymosis was noted. During palpation the lateral malleolus and distal ⅓ of the fibula were point tender. Special tests were performed to rule out fracture and ligament damage; Squeeze Test (-), Bump Test (-), Anterior Drawer (+ for pain), Talar Tilt Inversion and Eversion (-). After testing, the ankle and distal ⅓ of the fibula swelled rapidly, increasing point tenderness, and the squeeze test became positive. He was given crutches, a compression sleeve, and instructed to go to the ER for diagnostic imaging.
- Fracture of distal ⅓ of fibula
- ATF ligament sprain
- Rupture of Peroneal Retinaculum
TEST AND RESULTS: Radiographs of the R ankle and lower leg (LL).
–Nondisplaced fibular fracture.
Weight bearing (WB) radiograph was ordered after he slipped and fell.
–Could not stand during imaging due to extreme pain; the radiograph was postponed.
–One week later imaging revealed the bone remained nondisplaced.
FINAL WORKING DIAGNOSIS: Spiral Fracture of Distal ⅓ of Fibula
TREATMENT AND OUTCOMES:
- Alternated between hard cast, crutches, and walking boot due to physician disagreement for 2 weeks. Subsequently, spent 1 week in a hard cast and 3 weeks in a walking boot.
- Athlete was instructed to gently perform ROM exercise on his own, but forbidden to begin physical therapy (PT) per orthopedic.
- 7 weeks after initial injury, transitioned to ankle brace and was instructed to begin full WB ambulation.
- Rehabilitative exercises began ~7-8 weeks after initial injury. Initial rehabilitation included: daily active and passive ROM, light calf and ankle strengthening exercises, and WB exercises.
- 9 weeks post injury began PT focusing on lower leg and ankle strength. Implemented Laser Therapy pre and post treatment, Instrument Assisted Soft Tissue Mobilization, and a plyometric program for calf and ankle strength.
- Returned to play 13 weeks post injury, wearing ankle brace.
Dowd, Dalton; Bunal, Korey; and Boolani, Ali
"Lower Leg Injury — Basketball,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
1, Article 5.
Available at: https://digitalcommons.wku.edu/ijesab/vol15/iss1/5