Subjective:
Patient presents today with ongoing pain in their left ankle, sustained during a netball game three weeks ago. The patient reports a twisting mechanism of injury. They have been following the home exercise program (HEP) and are reporting a gradual improvement in pain levels, currently rating it as a 3/10 at rest and 5/10 during activity. They report that they are able to walk without a limp, but still experience some stiffness in the mornings.
Patient valued outcomes (PVOs):
The patient's goals are to return to playing netball at their previous level of performance and to be able to run and jump without pain.
Objective Assessment:
Palpation: Tenderness to palpation over the anterior talofibular ligament (ATFL) and the lateral malleolus. No significant swelling noted.
ROM (Range of Motion): Ankle dorsiflexion: 10 degrees (reduced compared to the unaffected side). Ankle plantarflexion: 45 degrees. Inversion and eversion are within normal limits.
Strength: Pain-free strength in all directions. Slight weakness noted with resisted ankle inversion.
Proprioception: Reduced proprioception noted on the left ankle compared to the right.
Gait: Normal gait pattern observed.
Squat: Able to perform a single-leg squat on the right leg, but unable to do so on the left leg due to pain and instability.
IMPRESSION:
Left ankle sprain, likely grade 1-2. Reduced range of motion and proprioception. Patient is making good progress with current management.
PLAN:
Continue with current HEP. Progress exercises as tolerated. Review in one week.
TREATMENT:
Manual therapy to the ankle joint to improve range of motion. Proprioceptive exercises using a wobble board.
HEP (Home Exercise Programme):
Continue with ankle range of motion exercises (dorsiflexion, plantarflexion, inversion, eversion). Progress to single-leg balance exercises. Begin with 30 seconds holds, 3 times a day.
ADVICE:
Continue to ice the ankle after activity. Avoid activities that provoke pain. Gradually increase activity levels as tolerated.
NEXT DAY:
Continue with current management plan.
