Fractured lower leg case study

Recently, Tim, a young lad aged 12, came to see me having sustained a severe fracture of his right lower leg whilst playing rugby. The fracture was close to the ankle joint and was so serious that at one point the pulse to the foot was lost. However, through the skilful work of the orthopaedic surgeon, they were able to restore the nerve and blood supply to the foot.

When Tim came to see me he had only been out of plaster for a week. He limped into the clinic on two crutches, still feeling very vulnerable. It was obvious that I wasn’t going to be able to do much directly to the ankle during the first session so instead we looked at how his injured ankle reacted to the upper body moving. With Tim standing, while holding onto the couch, I asked him to turn his torso from left to right. The chain reaction as his trunk moved was that the instep of his foot flattened and reformed. So he was getting ankle movement whilst standing, without any pain, and this was an exercise he could immediately go home and do.

Over the next few weeks, I continued to work with Tim on balance and general core strength so that the rest of his body stayed fit and strong. Gradually he was able to bear an increasing amount of weight through the injured ankle. We then moved onto work on his ability to step forwards, backwards and side to side.

As Tim gained confidence he also began to go swimming and also use an exercise bike. The next phase was to build up his stamina and the ability of the ankle to control the landing phase of walking and to spring off again.

Eight weeks out of plaster, Tim is able to knock a tennis ball around, hop and jump. Not only is his ankle pain free but he is generally fitter and stronger through the set of exercises I have set him.

So why am I telling you this story? It illustrates how we focused on what Tim could do at that moment rather than what he couldn’t do or the long journey to recovery ahead. By developing his confidence, we created a virtuous circle where he felt it was worth practising the exercises I gave him at home. We never performed exercises to ‘strengthen’ the ankle or worried about the range of movement. These components looked after themselves as the body as a whole learnt to adapt.

As an Osteopath, I continue to offer effective hands-on-treatment but I also use individually constructed exercise programmes to help clients return to recovery.