Basketball -Ankle Injury Of Telehealth Rehabilitation

HISTORY: A 27-year-old semi-professional basketball player injured his left ankle while landing on another player’s foot resulting in sharp pain and loss of weight-bearing ability immediately. He developed significant swelling, redness and bruising around the lateral malleolus, with no numbness, tingling or radiating pain into his forefoot or lower calf. He was recommended 6-weeks of immobilization and elected to attend telehealth sports medicine provider for evaluation PHYSICAL EXAMINATION: Telehealth examination revealed moderate tenderness and swelling over the left lateral malleolus, with a girth measurement of 27 cm compared to 25.5 cm on the right. He self-reported 30% inversion and eversion muscular strength deficit on left versus right. While there was close to full range of motion in active plantar and dorsiflexion, self-manual muscle testing elicited pain. Patient described a running gait of reduced foot contact due to pain and stiff sensation in the ankle. DIFFERENTIAL DIAGNOSIS:1. Tibiofibular Syndesmosis ligament sprain 2. Distal talus fracture 3. Fibularis longus and brevis strain TEST AND RESULTS: Left ankle magnetic resonance imaging: —Moderate edema on lateral malleolus and cuboid with bone bruises—Fibular longus muscle strain —Incomplete tear of Anterior talofibular and calcaneofibular ligaments with mild Achilles tendinitis—Normal orientation of distal fibular and tibial TREATMENT AND OUTCOMES: 1. 8 weeks Telehealth rehabilitation: education, therapeutic exercises, self-mobilization of calcaneal and distal fibular head, self-recording treatment with online feedback from physical therapists2. 0-2 weeks - active ankle inversion, eversion, ankle dorsiflexion and plantarflexion with resisted theraband, single leg standing and full body weight bearing squat on BOSU, foot intrinsic muscle strength 3. 3-5 weeks: 15 min jogging of 4.5mph - reduce ankle swelling 0.5 cm the next day after the first treatment, gradually increase the aerobic intensity and continue ankle muscular strength exercises4. 7-8 weeks: lower extremity plyometric, double/single leg jumping over hurdle, agility and squat jump with basketball-specific drills training