Background: A 48-year-old male developed pain and edema in his right foot and an
ID: 3472587 • Letter: B
Question
Background: A 48-year-old male developed pain and edema in his right foot and ankle subsequent to stepping in a hole in his yard while mowing his lawn. Treated at his local hospital's emergency room: he failed to comply with their instructions to elevate and ice the injured extremity and reported to his family I^72 sician 48 hours later with a moderately swollen and ecchymotic right ankle. The patient reported the obvious swelling, localized tenderness over the lateral aspect of the ankle and difficulty with weight-bearing during ambulation. Physical examination revealed point tenderness at the ATF (anterior talofibular ligament), 2+ effusion - figure 8 girth increased by 3/4" versus uninvolved side, and reduced ROM of dorsiflexion to 0 degrees/plantarflexion to 35 degrees. The ankle was stable to anterior drawer and talar tilt tests. Impression: Subacute grade I inversion sprain right ankle Treatment Plan: In addition to reinstruction in home care principles: a course of intermittent compression was initiated to the right foot/ankle to mobilize the residual effusion/edema. The right lower extremity was elevated, pre-treatment circumferential measurements taken and stockingnette placed over the extremity. Treatment consisted of 60mm Hg pressure applied intermittently for 30 seconds on/10 seconds off cycles for 30 minutes duration. Post-treatment circumferential measures were taken and the patient encouraged to attempt active and active-assisted ankle pumping exercise. Patient was fitted with a compression stocking and thermoplastic ankle stirrup for ambulation weight-bearing as tolerated. Response: Post initial treatment, patient's circumferential measures were reduced by 1/4" Dorsiflexion range of motion increased by 5 degrees. Over the course of five treatment sessions, effusion was resolved and active range of motion approached normal limits. Strengthening exercises were implemented and the patient continued to ambulate with the aid of the ankle stirrup. At the time of discharge the patient was essentially symptom free, independent in performing his strengthening regimen and 1. What specific tissue was injured in this patient?
Explanation / Answer
1) The specific tissue that got injured in this patient is anterior talofibular ligament which causes tenderness resulting in edema. So, intermittent compression is provided as a treatment.
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