Client Bio
Here, Shane Brennan, our foot and ankle specialist physiotherapist, describes a recent case where he supported a patient through the rehabilitation of an ankle surgery, successfully successfully returning him to running and back on the golf course.
Client Bio
Patient Y is a 31 year old male accountant, who plays golf regularly and runs weekly 5ks for exercise.
Background
Patient Y first attended my foot and ankle clinic approximately four months ago, following an avulsion fracture of his right ankle.
An avulsion fracture of the ankle occurs when a ligament or tendon pulls a small piece of bone away during a sudden twist or roll of the foot. It often feels similar to a bad ankle sprain and is commonly treated in a similar way initially. If pain or stiffness persists, specialist assessment is important to ensure proper healing and safe return to activity.
The patient had completed an initial period of rehabilitation elsewhere and had been progressing reasonably well until he developed persistent medial ankle pain. This pain became particularly noticeable during hopping and jumping exercises, and significantly affected his ability to push off the foot and follow through during his golf swing.
The Challenge
On assessment, the most significant finding was severely restricted ankle dorsiflexion (which means the ankle has a very limited ability to bend upwards). This limitation was not responding to appropriate mobilisation, strengthening, or offloading strategies. Given the lack of progress and ongoing pain, I felt it was important at this stage to seek a surgical opinion.
The initial recommendation from the consultant was a steroid injection. This resulted in a short-term reduction in pain and a temporary improvement in dorsiflexion range of movement.
Rehabilitation then progressed to focus on balance and strengthening. However, while these elements improved, there was a concurrent recurrence of medial ankle pain and a reduction in active dorsiflexion, which made me concerned about an underlying mechanical restriction.
The Solution
Following a subsequent review with the surgeon, the decision was made to proceed to surgery, and the patient had a ‘debridement and medial stabilisation’ procedure in Santry Sports Clinic, Dublin.
Post-operatively, there was a significant reduction in ankle dorsiflexion along with reduced strength and balance (which would be common), but happily, the surgery was a success overall, and we were cleared for physiotherapy.
Over the course of several months, we structured Patient Y’s rehabilitation to fully restore ankle movement, strength, and confidence. Early treatment focused on settling pain and swelling and gradually restoring ankle dorsiflexion, which had been a key limiting factor throughout his recovery. As movement improved, rehabilitation progressed to targeted strengthening and balance work, followed by controlled reintroduction of impact and rotational movements specific to running and the golf swing.
The Results
With regular physiotherapy, careful load management and excellent adherence to his rehab programme, I’m delighted to say that this patient has made great progress.
His knee-to-wall test has improved from 30 mm to 110 mm, placing him well within the normal range. His strength has improved beyond baseline levels and his balance has returned to normal.
Patient Y has now returned to running 5km weekly and is playing golf regularly. Most importantly, he is now pain free, moving with comfort and enjoying sport once again.
Key Take-Home Points
- Persistent pain and loss of movement following an ankle injury should not be ignored, particularly if progress stalls despite appropriate rehabilitation.
- Imaging and injections can be useful tools, but they must be interpreted alongside clinical assessment by a specialist physiotherapist.
- In some cases, surgery is required to address underlying mechanical restrictions that cannot be resolved conservatively.
- Post-surgical ankle rehabilitation is just as important as the surgery itself and must be structured, progressive and tailored to the individual and their sport.
- The input of a specialist foot and ankle physiotherapist plays a key role in restoring movement, confidence, and performance, while reducing the risk of long-term dysfunction or recurrence.
Learn More
Visit Shane’s website bio, or learn more about the foot and ankle clinic at Mid West Physiotherapy.
Online booking is available for this service; no doctor’s referral needed.