Week 5

Situation
On the final week of my placement, a patient was referred to me from a doctor in the emergency department at Broome health campus. My patient was a 23 year old man that had a suspected tear of his anterior talo-fibular ligament . He did the accident 1 day ago while jumping off a truck, he rolled his right ankle inwards. At the time of the injury there was no crack but he immediately felt pain in the ankle and he could not walk on it. This man had an x-ray performed of his right foot, on the day the ankle was injured, the x-ray revealed no broken bones.
He told me that he had broken his fibula 5 years ago on the left and had sprained both his ankles multiple times.
He drives trucks on a farm and is anxious about when he can return to work.

I performed a subjective and objective assessment. On the objective assessment I found he was very tender around the lateral aspect of the malleolus and the ankle itself was grossly swollen. His active range of motion was also limited in all directions. He also couldn’t walk on the ankle at all. He was mobilising with auxiliary crutches.

Task
My task was to treat this man for his suspected tear of the anterior talo-fibular ligament.

Action
I talked to this man about his injury, showed him where the ligament was on a diagram and then told him his expected healing time. I then performed ultrasound on this man for 5 minutes. I then educated him about the swelling management; icing the ankle for 15 minute time slots, elevating it on pillows, and resting it. I also gave him some tubi-grip to help with compression. I then taped the ankle up using sports tape.

Result
I ended up giving this man a 35 minute treatment session where I gave him acute management techniques for his expected tear of the anterior talo-fibular ligament.

Evaluation
I think that I explained the condition to this man well and gave him a good explanation of his expected recovery time. I think I also performed the ultrasound well ( using acute settings) and gave him good swelling management techniques.
I don’t think my taping was good at all. I think i had far too many crinkles in the tape. I also think some of the pieces of tape were too short, to provide adequate support while other pieces of tape were too tight on his foot, especially when he stood up, he said it felt very tight across his forefoot. I had to reapply the ‘heel-locks’, many times because I don’t think I positioned the tape in the right place, I defiantly need more practice at this strapping technique.

Strategies
I thought of some strategies to help me the next time I came across an ankle that needed taping.
- Make sure the ankle is in neutral (planter-grade) or even with the toes pointing a little upwards (dorsiflexion) before I begin taping.
- I think I could gain a lot of practice from taping other people’s feet. I will try to use the taping techniques on my friends and family.
- In the initial stages of an ankle strain, compression is the objective, so in these stages I must apply tape liberally over the ankle using techniques such as stirrups, and bilateral heels locks etc. with the objective of using the tape to reduce the swelling.
- After a lot of the gross swelling has gone down, supporting the ankle is imperative, and preventing it from re-injuring in vulnerable directions. So in an inversion injury applying the tape to prevent inversion would be the best course of action, in the sub-acute stages.
- Next time I will splaying the metatarsals wide before taping across the forefoot (using your fist on the planter surface of the ball of the patients foot) so that I don’t cause too much compression across the foot.
- I thought that I could measure the tape on the non-adhesive side before ripping it off. This way I will never have a piece of tape that is too short.