From the Research
Treatment for this complex ankle injury should begin with a comprehensive approach including both non-surgical and potentially surgical options, prioritizing early functional treatment and supervised rehabilitation to promote the fastest recovery and least rate of reinjury, as recommended by 1 and supported by the most recent guidelines 2. The injury involves heterogeneity, thickening, and split in the peroneus brevis tendon, absent Anterior Talofibular Ligament (ATFL), fluid in the flexor hallucis longus tendon, and a non-visualized deltoid ligament, indicating a need for careful management to address potential ankle instability and prevent long-term morbidity. Key components of the treatment plan include:
- Initial management with the RICE protocol (Rest, Ice, Compression, Elevation) and non-weight bearing or protected weight bearing using crutches or a walking boot for 4-6 weeks.
- Pain management, for which the use of NSAIDs like ibuprofen or naproxen is controversial due to potential effects on healing, as discussed in 3 and 4, suggesting paracetamol as a safer alternative for analgesia.
- Physical therapy started after the acute phase, focusing on peroneal strengthening exercises, proprioception training, and gradual return to activity over 8-12 weeks, as this approach is associated with better outcomes and fewer reinjuries, according to 1 and updated guidelines 2.
- Consideration of a functional ankle brace for support, especially given the peroneus brevis tendon damage and potential ankle instability.
- Close monitoring and potential surgical intervention for the absent ATFL and questionable deltoid ligament integrity if conservative treatment fails, which could involve tendon repair or reconstruction of the lateral ligament complex.
- Management of the fluid in the flexor hallucis longus tendon, which suggests tenosynovitis and typically responds to conservative measures. Regular follow-up with an orthopedic specialist is crucial to adjust the treatment plan as needed and ensure the best possible outcome in terms of morbidity, mortality, and quality of life.