PE REPORT Patient's Name: Leslie J. Hunt Complaints: Pain in the right ankle. Occurred after a game of basketball. Wants to play in finals in 5 weeks time.
Diagnosis: Mr. Hunt has a sprain in the outside ankle. I recommend he follow the suggested treatment if he wished to participate in the finals.
Treatment Already Completed: The coach escorted Leslie off the court. R.I.C.E (Rest, Ice, Compression and Elevation) has been completed successfully.
Suggested Treatment Short Term: I have recommended for Leslie to get a x-ray. This will make sure no structural damage has occurred in the ankle. If nothing comes up I urge him to continue R.I.C.E. The best form of icing the foot would be placing the ankle in a bucket of cold water. Leave in the water for a maximum of 20 minutes then compress the ankle with a crepe bandage. Ankle must be rested above the heart.
So lying down on the floor or a coach with the ankle rested above will greatly help. Keep the bandage on and alternate ice treatment and elevation every 20 minutes 12-24 hours until swelling begins to disappear. Once the swelling has been controlled the next step of including hot water has to be fulfilled. Immerse the foot in hot water for 1 minute then change to cold water for 2 minutes. This process needs to be alternated for 20-30 minutes 3 times a day. Continue until obvious signs of swelling decrease this will be about 2-3 days. After the 72 hours or swelling has decreased use heat by itself. If swelling returns to the region he will need to revert to cold as well. Exercises commence 48 after injury. They must be kept within limits of pain and shouldn't be violent enough to cause swelling. Continual progress will be made until full weight can be place onto the ankle comfortably. Joint sense takes longer to heal than strength and mobility so balancing exercises should be carried out for several months for a full recovery. If swelling appears while doing exercises return back to I.C.E. and exercise more gently.
Long Term: These exercises will need to be carried out religiously.
a) From a standing position, rock back on to hells, bringing the soles of feet off the floor, then raise up on to toes so that heels are off floor. Repeat 40 times.
b) Remove shoes and walk along on outside edges of feet. 20 meters.
c) Wearing shoes, stand on the edge of a step. Raise heels as much as possible. Hold for 4 seconds, then lower heels until a stretch pain is felt in calf. Repeat 20 times.
d) Bend the knee, point the toe and turn the forefoot in as much as possible. Grasp the forefoot with you hand, and against the resistance of your hand, bring the foot back to the neutral position, over 6 seconds. Repeat 5 times.
e) Put both feet inside a circle of cycle inner tube. Push outwards against the resistance of the tube. Also do this exercise with the tube looped over a board 250mm wide whilst standing on the board. Do for 2 minutes.
f) Spread a towel lengthwise on the floor with a 2 kg weight on one end. With the heels firmly on the ground, at the other end of the towel, move the towel sideways against the resistance of the weight by using the foot muscles. Repeat 4 times.
g) As much stationary cycling as can be tolerated with the saddle raised as much as possible.
h) On a gradual slope, run or walk in a figure of eight along the side of the slop progressively decreasing the size of the figure eight.
i) Standing on one foot, bounce and catch a ball off the wall for 2-4 minutes.
j) Using a balance board with either one or two feet, keep it balanced for as long as possible, by using the muscles in the side of the calf.